Current status and future advances of intestinal autotransplantation
Objective To explore the safety and practicality of intestinal autotransplantation(IATx)combined with radical tumor resection in the treatment of intraperitoneal tumors involving vital blood vessels.Method The research progress on indications,preoperative evaluation,ex vivo organ preservation techniques,and mesenteric vascular reconstruction techniques for IATx from January 1996 to August 2023 both domestically and internationally was reviewed.Results The IATx had become a feasible surgical option for the patients with intraperitoneal tumors involving vital blood vessels(more than 180° involving the root of the superior mesenteric artery).The related studies had identified that the intraperitoneal tumors involving vital blood vessels mainly originated from the pancreas,mesentery,and retroperitoneum.Establishing a multidisciplinary team for preoperative assessment of IATx could aid to establish a valuable diagnostic and treatment system.The keypoints of IATx mainly included IATx preparation(cutting and ligating mesenteric blood vessels),in vivo tumor resection,cryopreservation of intestine in vitro,vascular and gastrointestinal reconstruction after IATx,which was different viewpoints in the different literature,such as the selection of in vivo/in vitro tumor resection,mesenteric vascular reconstruction,and portal or vena cava drainage.However,there was a consensus that the optimal solution for ex vivo organ preservation technology was improved solutions relevant to UW.At present,the hot ischemia time of intestine graft was shortened,the incidence of postoperative intestinal graft loss was reduced,and the postoperative survival of patients was gradually extended.But there were still some unresolved complications,such as early graft loss,pancreatic leakage,delayed gastric emptying,postoperative bleeding,etc.Conclusions IATx combined with tumor resection for intraperitoneal tumors involving vital blood vessels is feasible through carefully preoperative evaluation and surgical planning,which could provide a good clinical and prognostic result.But this operation requires higher technical requirements and might only be performed in centers with rich experience in intestinal transplantation.
intestinal autotransplantationvascular reconstructionex vivo organ preservation
NETL
NSTL
万方数据
