2007-03 - Intestinal Autotransplantation For Adenocarcinoma of Pancreas Involving The Mesenteric Root - Our Experience and Literature Review PDF
2007-03 - Intestinal Autotransplantation For Adenocarcinoma of Pancreas Involving The Mesenteric Root - Our Experience and Literature Review PDF
2007-03 - Intestinal Autotransplantation For Adenocarcinoma of Pancreas Involving The Mesenteric Root - Our Experience and Literature Review PDF
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Pancreas & Volume 34, Number 2, March 2007 Intestinal Autotransplantation for Pancreatic Adenocarcinoma
Copyr ight © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Quintini et al Pancreas & Volume 34, Number 2, March 2007
in both cases. No major hypoglycemic crisis was reported, and a carcinoma of the pancreas. In our report, we describe 2 cases
good glucose level control was achieved in both patients. Periodic of ductal adenocarcinoma of pancreas treated with such a
close follow-up visits with serial CT scans, ultrasonography, and technique. The decision to undertake this option derived from
laboratory data showed no evidence of tumor recurrence until after the major invasion of mesenteric root by the tumor, from the
16 and 9 months. One patient experienced PV thrombosis 15 months
absence of liver and peritoneal metastasis, the excellent
after operation, with signs of peritoneal carcinosis. He died 19
months after operation. The other patient returned to work 40 days clinical status, and the young age of the patients at the time of
after operation and experienced optimal clinical conditions until diagnosis, and, finally, from a well-motivated intention of the
massive liver metastatic involvement, peritoneal carcinosis, and patients to undergo a high-risk critical but potentially curative
death occurred 10 months after the operation. procedure, although remote. As described by Tzakis et al,3 the
ex sito perfusion and dissection can help provide an adequate
tumor-free margin in 2 crucial areas such as the mesenteric
DISCUSSION pedicle, where isolation is conducted as far as safe tissue is
It is widely accepted that surgical excision of tumor encountered, and the retroperitoneal aspect of pancreatic bed,
tissue associated with adjuvant therapy represents the only which is frequently invaded by tumoral tissue even in case of
chance of cure for patients with ductal adenocarcinoma of small tumors. From a technical point of view, due to its role in
pancreas. The analysis of major series clearly establishes that the transit time regulation, to prevent short-bowel syndrome
the only prognostic factor predicting long-term survival rate and its clinical-functional consequences, the ileocecal valve
is the invasion of resected margins by the tumor. There is no should be preserved, and although the minimum length of
accordance on whether infiltration of PV/SMV should be intestine necessary to maintain nutritional status has not been
considered a negative prognostic factor and then a contra- established, a 100-cm-long part of the small intestine is
indication to curative resection.1,2 Whether some authors thought to be enough to maintain sufficient function. In our
believe that vascular invasion should be considered as a 2 cases, a good quality of life was ensured for a reasonable
synonym of remote spread of the tumor, others support the time before recurrence, as deducted comparing our follow-up
concept proposed by Fuhrman et al1 that venous involvement period with median survival time reported in literature for
is a reflection of tumor size and location rather than an stage IV pancreatic cancer.5 Furthermore, the analysis of 7
indicator of aggressive tumor biology. Moreover, others have cases performed so far shows that no perioperative mortality
reported high rates of overestimation in intraoperative vein occurred, ensuring that in highly selected patients and centers
invasion assessment, demonstrating that in most specimens, with intestinal transplant experience, this procedure can be
the tumor abutted the PV/SMV without infiltrating the venous performed with acceptable rates of mortality and morbidity.
wall.6 As proposed by Van Geenen et al,2 the macroscopic Because of the paucity of intestinal autotransplantation
appearance of tumor infiltration can be explained by the performed and to the biologic aggressiveness of this tumor, it
desmoplastic stromal reaction of the tumor, which cannot is very difficult, as in many pancreatic resections, to settle the
macroscopically be distinguished from tumor infiltration. border between palliation and cure. Despite this, we believe
According to these concepts, any technical advance able to that a young individual in excellent clinical status with a local
increase the curative resection rate can potentially reflect an invasion of the mesenteric pedicle (in the absence of
increase in survival rate, especially in those patients in whom peritoneal/liver metastasis and aware of the risk that such a
curative resection is denied because of the involvement of the procedure implies) still has the right to pursue a cure even if
mesenteric root. Many reports in literature describe the ex the chance is infinitesimal.
vivo resection of the tumor in heart, liver, and kidney
surgeries. According to this technique, the organ is removed REFERENCES
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