In vivo Hypothermic Perfusion Intestinal Auto-transplantation for Patients With Tumors Invading the Mesenteric Root Vascular System: An Unusual Consecutive 19-case Series (with video).

Abstract

The aim of this study was to investigate the safety and outcomes of radical resection combined with in vivo hypothermic perfusion and intestinal auto-transplantation (IATx) for tumors invading the mesenteric root vascular system. Radical resection combined with IATx is safe and effective for mesenteric root tumors invading the vascular system. However, classic IATx procedures require removing the mesenteric root tumor as well as the small intestine and ascending colon for ex vivo hypothermic perfusion. These conditions result in more gastrointestinal anastomoses and resection of the ileocolonic junction, thereby extending the operation time and increasing the risk of severe complications postoperatively. In this study, the safety, feasibility, efficacy, and outcomes of alternative in vivo hypothermic perfusion and IATx were explored. This retrospective study analyzed data from 19 patients who underwent in vivo hypothermic perfusion and IATx for mesenteric root tumors invading the vascular system, especially the superior mesenteric artery (SMA) and superior mesenteric vein (SMV), between June 2022 and January 2024. The operative parameters, pathological findings, and surgical outcomes were systematically analyzed. All patients successfully underwent in vivo hypothermic perfusion combined with IATx. The average operation time was 10.5 hours, with all patients achieving negative surgical margins. Indocyanine green fluorescence imaging revealed a stable blood supply to the intestines from the SMA. None of the patients experienced postoperative gastrointestinal bleeding or anastomotic leakage. Additionally, no patient died perioperatively or needed intravenous fluid infusion after discharge. Among the 19 patients included in this study, 3 had locally recurrent tumors resulting in 1 death; 3 had liver metastasis, while 13 exhibited no signs of recurrence or metastasis. In vivo hypothermic perfusion combined with IATx represents a safe and feasible option for treating mesenteric root tumors invading the vascular system, representing a curative approach in a selected patient group. However, further investigations of long-term oncological outcomes and multidisciplinary studies are needed to validate these findings.