Intestinal autotransplantation for adenocarcinoma of pancreas involving the mesenteric root: our experience and literature review.

Ductal adenocarcinoma of pancreas represents one of the most aggressive tumor as demonstrated by 3- and 5-year survival rates. Involvement of mesenteric pedicle affects both the possibility to perform a tumor-free margin resection and accounts for most exploratory laparotomy for locally advanced disease. The ex vivo resection of the tumor (autotransplantation) after total exenteration and perfusion of the intestine might have a role to overcome some technical obstacles. So far, only 5 patients have been reported to have undergone small-bowel autotransplantation for tumor involving the mesenteric root. We describe 2 cases of adenocarcinoma of pancreas involving mesenteric root treated by small-bowel autotransplantation. Both patients survived from the procedure and were discharged home on postoperative days 16 and 29, respectively. The tumor was resected with free surgical margins, and both patients underwent adjuvant treatment. Intestinal autotransplantation can represent a significant technical advance for increasing the resectability rate and, ultimately, the survival rate for advanced adenocarcinoma of the pancreas in highly selected patients.