Langenbeck's Archives of Surgery

, Volume 401, Issue 8, pp 1249–1257 | Cite as

Intestinal autotransplantation for neoplasms originating in the pancreatic head with involvement of the superior mesenteric artery

  • Guosheng WuEmail author
  • Xin Wang
  • Qingchuan Zhao
  • Weizhong Wang
  • Hai Shi
  • Mian Wang
  • Jingson Zhang
  • Zengshan Li
  • Daiming Fan
How-I-Do-It Articles



We describe the operative techniques and perioperative morbidity of intestinal autotransplantation (IATx) for neoplasms originating in the pancreatic head with involvement of the superior mesenteric artery (SMA), particularly focusing on oncological outcomes of patients with ductal adenocarcinoma.


Six patients with pancreatic head neoplasms aged 20 to 67 years underwent IATx in our center from January 2012 to January 2016. The operative procedure involves (1) selection and procurement of a segment of small intestine as the autograft, (2) completion of an en bloc resection of the tumor along with involved organs, and (3) autotransplantation of the autograft.


In all six patients, the median operative time was 12.1 h (range, 9.5–16.5) with a median blood transfusion of 7 units (range, 4–10). All patients had margin-negative resections. Complications occurred in three of six patients with no perioperative mortality. The median duration of hospital stay was 19 days (range, 15–26). These six patients have had a well-functioning autograft and have not required any intravenous fluid hydration since discharge. At 5.9-, 10.9-, and 12.4-month follow-ups, serum levels of CA19-9 remained normal in two and elevated in one of three patients with ductal adenocarcinoma. At a median follow-up of 12.1 months (range, 4.9–42.9), all patients have remained alive without evidence of local recurrence and gross metastatic disease.


IATx combined with extensive pancreaticoduodenectomy and SMA resection can be performed in highly selected patients with an acceptable morbidity and mortality. Careful preoperative assessment and planning are the keys to the success of this aggressive operation.


Intestinal autotransplantation Pancreatic head neoplasms Extensive resection SMA resection 



The authors would like to thank the surgical team and the nursing staff at the Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, for their excellent patient care. The authors thank Mr. Yinglun Wu for help with English grammar.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

Ethics committee approval was obtained from Xijing Hospital, the Fourth Military Medical University.


This work has no funding support.


  1. 1.
    Werner J, Combs SE, Springfeld C, Hartwig W, Hackert T, Buchler MW (2013) Advanced-stage pancreatic cancer: therapy options. Nat Rev Clin Oncol 10:323–333CrossRefPubMedGoogle Scholar
  2. 2.
    Hackert T, Schneider L, Buchler MW (2015) Current state of vascular resections in pancreatic cancer surgery. Gastroenterol Res Pract 2015:120207CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Gluth A, Werner J, Hartwig W (2015) Surgical resection strategies for locally advanced pancreatic cancer. Langenbecks Arch Surg 400:757–765CrossRefPubMedGoogle Scholar
  4. 4.
    Mollberg N, Rahbari NN, Koch M, Hartwig W, Hoeger Y, Buchler MW, Weitz J (2011) Arterial resection during pancreatectomy for pancreatic cancer: a systematic review and meta-analysis. Ann Surg 254:882–893CrossRefPubMedGoogle Scholar
  5. 5.
    Martin RC 2nd, Scoggins CR, Egnatashvili V, Staley CA, McMasters KM, Kooby DA (2009) Arterial and venous resection for pancreatic adenocarcinoma: operative and long-term outcomes. Arch Surg 144:154–159CrossRefPubMedGoogle Scholar
  6. 6.
    Christians KK, Pilgrim CH, Tsai S et al (2014) Arterial resection at the time of pancreatectomy for cancer. Surgery 155:919–926CrossRefPubMedGoogle Scholar
  7. 7.
    Capussotti L, Massucco P, Ribero D, Vigano L, Muratore A, Calgaro M (2003) Extended lymphadenectomy and vein resection for pancreatic head cancer: outcomes and implications for therapy. Arch Surg 138:1316–1322CrossRefPubMedGoogle Scholar
  8. 8.
    Chua TC, Saxena A (2010) Extended pancreaticoduodenectomy with vascular resection for pancreatic cancer: a systematic review. J Gastrointest Surg 14:1442–1452CrossRefPubMedGoogle Scholar
  9. 9.
    Zhou Y, Zhang Z, Liu Y, Li B, Xu D (2012) Pancreatectomy combined with superior mesenteric vein-portal vein resection for pancreatic cancer: a meta-analysis. World J Surg 36:884–891CrossRefPubMedGoogle Scholar
  10. 10.
    Noto M, Miwa K, Kitagawa H, Kayahara M, Takamura H, Shimizu K, Ohta T (2005) Pancreas head carcinoma: frequency of invasion to soft tissue adherent to the superior mesenteric artery. Am J Surg Pathol 29:1056–1061PubMedGoogle Scholar
  11. 11.
    Donahue TR, Reber HA (2015) Surgical management of pancreatic cancer—pancreaticoduodenectomy. Semin Oncol 42:98–109CrossRefPubMedGoogle Scholar
  12. 12.
    Bockhorn M, Uzunoglu FG, Adham M et al (2014) Borderline resectable pancreatic cancer: a consensus statement by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 155:977–988CrossRefPubMedGoogle Scholar
  13. 13.
    Verbeke CS, Leitch D, Menon KV, McMahon MJ, Guillou PJ, Anthoney A (2006) Redefining the R1 resection in pancreatic cancer. Br J Surg 93:1232–1237CrossRefPubMedGoogle Scholar
  14. 14.
    Lad NL, Squires MH, Maithel SK et al (2013) Is it time to stop checking frozen section neck margins during pancreaticoduodenectomy? Ann Surg Oncol 20:3626–3633CrossRefPubMedGoogle Scholar
  15. 15.
    Liu L, Katz MH, Lee SM et al (2015) Superior mesenteric artery margin of posttherapy pancreaticoduodenectomy and prognosis in patients with pancreatic ductal adenocarcinoma. Am J Surg Pathol 39:1395–1403CrossRefPubMedGoogle Scholar
  16. 16.
    Tzakis AG, De Faria W, Angelis M, Verzaro R, Pinna A (2000) Partial abdominal exenteration, ex vivo resection of a large mesenteric fibroma, and successful orthotopic intestinal autotransplantation. Surgery 128:486–489CrossRefPubMedGoogle Scholar
  17. 17.
    Tzakis AG, Tryphonopoulos P, De Faria W et al (2003) Partial abdominal evisceration, ex vivo resection, and intestinal autotransplantation for the treatment of pathologic lesions of the root of the mesentery. J Am Coll Surg 197:770–776CrossRefPubMedGoogle Scholar
  18. 18.
    Quintini C, Di Benedetto F, Diago T et al (2007) Intestinal autotransplantation for adenocarcinoma of pancreas involving the mesenteric root: our experience and literature review. Pancreas 34:266–268CrossRefPubMedGoogle Scholar
  19. 19.
    Amano H, Miura F, Toyota N et al (2009) In situ surgical procedures for locally advanced pancreatic cancer: partial abdominal evisceration and intestinal autotransplantation. J Hepatobiliary Pancreat Surg 16:771–776CrossRefPubMedGoogle Scholar
  20. 20.
    Kato T, Lobritto SJ, Tzakis A et al (2012) Multivisceral ex vivo surgery for tumors involving celiac and superior mesenteric arteries. Am J Transplant 12:1323–1328CrossRefPubMedGoogle Scholar
  21. 21.
    Tzvetanov IG, Bhati CS, Jeon H, Glover AE, Oberholzer J, Benedetti E (2012) Segmental intestinal autotransplantation after extensive enterectomy for removal of large intra-abdominal desmoid tumors of the mesentery root: initial experience. Surgery 151:621–624CrossRefPubMedGoogle Scholar
  22. 22.
    Wu G, Zhao Q, Wang W et al (2016) Clinical and nutritional outcomes after intestinal autotransplantation. Surgery doi:  10.1016/j.surg.2016.01.016.
  23. 23.
    Bachellier P, Rosso E, Lucescu I, Oussoultzoglou E, Tracey J, Pessaux P, Ferreira N, Jaeck D (2011) Is the need for an arterial resection a contraindication to pancreatic resection for locally advanced pancreatic adenocarcinoma? A case-matched controlled study. J Surg Oncol 103:75–84CrossRefPubMedGoogle Scholar
  24. 24.
    Hernandez F, Zou Y, Lopez G et al (2005) Is portal venous outflow better than systemic venous outflow in small bowel transplantation? Experimental study in syngeneic rats. J Pediatr Surg 40:336–340CrossRefPubMedGoogle Scholar
  25. 25.
    Berney T, Kato T, Nishida S et al (2002) Portal versus systemic drainage of small bowel allografts: comparative assessment of survival, function, rejection, and bacterial translocation. J Am Coll Surg 195:804–813CrossRefPubMedGoogle Scholar
  26. 26.
    Nikeghbalian S, Aliakbarian M, Kazemi K, Shamsaeefar AR, Mehdi SH, Bahreini A, Malek-Hosseini SA (2014) Ex-vivo resection and small-bowel auto-transplantation for the treatment of tumors at the root of the mesentery. Int J Organ Transplant Med 5:120–124PubMedPubMedCentralGoogle Scholar
  27. 27.
    Payne RF, Pain JA (2006) Duct-to-mucosa pancreaticogastrostomy is a safe anastomosis following pancreaticoduodenectomy. Br J Surg 93:73–77CrossRefPubMedGoogle Scholar
  28. 28.
    Xiong JJ, Tan CL, Szatmary P et al (2014) Meta-analysis of pancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy. Br J Surg 101:1196–1208CrossRefPubMedGoogle Scholar
  29. 29.
    Bassi C, Falconi M, Molinari E, Salvia R, Butturini G, Sartori N, Mantovani W, Pederzoli P (2005) Reconstruction by pancreaticojejunostomy versus pancreaticogastrostomy following pancreatectomy: results of a comparative study. Ann Surg 242:767–771, discussion 771–763CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Menahem B, Guittet L, Mulliri A, Alves A, Lubrano J (2015) Pancreaticogastrostomy is superior to pancreaticojejunostomy for prevention of pancreatic fistula after pancreaticoduodenectomy: an updated meta-analysis of randomized controlled trials. Ann Surg 261:882–887CrossRefPubMedGoogle Scholar
  31. 31.
    Keck T, Wellner UF, Bahra M et al (2016) Pancreatogastrostomy versus pancreatojejunostomy for RECOnstruction After PANCreatoduodenectomy (RECOPANC, DRKS 00000767): perioperative and long-term results of a multicenter randomized controlled trial. Ann Surg 263:440–449CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Guosheng Wu
    • 1
    Email author
  • Xin Wang
    • 1
  • Qingchuan Zhao
    • 1
  • Weizhong Wang
    • 1
  • Hai Shi
    • 1
  • Mian Wang
    • 1
  • Jingson Zhang
    • 2
  • Zengshan Li
    • 3
  • Daiming Fan
    • 1
  1. 1.Xijing Hospital of Digestive DiseasesThe Fourth Military Medical UniversityXi’anPeople’s Republic of China
  2. 2.Department of Radiology, Xijing HospitalThe Fourth Military Medical UniversityXi’anChina
  3. 3.Department of Pathology, Xijing HospitalThe Fourth Military Medical UniversityXi’anChina

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