Fourth Military Medical University, China
Guosheng Wu is a professor of the Gastrointestinal Surgery at the Xijing Hospital, Xi’an, China. I received my M.D. from the Fourth Military University and Ph.D. from the Karolinska Institute, Sweden. After ten-year training as a clinical transplant fellow both at the Miami Transplant Institute and the University of Pittsburgh Medical Center, I returned to Xi’an, Where I accepted a tenure position at the Xijing Hospital. In addition to routine GI surgery, I am especially focusing of clinical intestinal transplantation, intestinal auto-transplantation, and complicated Whipple’s procedure.
Abdominal tumors involving the root of the superior mesenteric and/or celiac arteries were deemed unresectable with conventional surgical techniques. We report a series of patients undergoing temporary removal of a healthy segmental intestine followed by radical tumor resection and autotransplantation of the excised intestine in our center and evaluate surgical indications, technical feasibility and clinical outcomes after this procedure. From March 2011 to June 2016, intestinal autotransplantation was performed in ten patients (9 males, 1 female; average age 52 years old). A primary diagnosis includes mesenteric desmoid tumor in 3, pancreatic pseudopapillary tumor in 2, pancreatic ductal carcinoma in 2, pancreatic neuroendocrine tumor in 2, and retroperitoneal ganglioneuroma in 1. All cases had a previous surgical history of a failed attempt to remove the tumors in outside institutions. One patient died secondary to ischemic acute pancreatitis 30 days after the procedure. The remaining nine patients survived with no evidence of tumor recurrence currently at an average of 18 months (range, 2-49 months) follow-up. Of those, one patient lost the intestinal autograft due to thrombosis of the superior mesenteric artery two days after surgery and has been thereafter dependent on total parenteral nutrition. The other 8 patients had a well-functioning autograft with no requirements for parenteral nutritional support or any intravenous fluid hydration since hospital discharge. Intestinal auto-transplantation is suitable for locally invasive mesenteric tumors with major vascular involvement and is associated with good outcomes for selective patients. The procedure is technically challenging and should be performed in a center experienced in intestinal transplantation.