Nikeghbalian S, Aliakbarian M, Shamsaeefar A, Kazemi K, Bahreini A, Malekhosseini S A
Department of Surgery, Namazi Hospital, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
Transplant Proc. 2013;45(10):3528-30. doi: 10.1016/j.transproceed.2013.09.002.
Some intra-abdominal or retroperitoneal tumors such as low-grade slow-growing malignancies may seem unresectable due to major vessel encasement or presence of intra-abdominal dissemination, but the slow growth rate and to some extent long life expectancy of the patients urge us to find some strategies to cure the patients or at least achieve tumor remission or symptom palliation. En bloc resection, followed by multivisceral or liver-sparing "modified" multivisceral transplantation has recently been used for treatment of these patients.
Between May 2010 and October 2012, 3 multivisceral and 3 modified multivisceral transplantations were performed in 6 patients (aged 14 to 55 years; mean, 32 years) with some slow growing intra-abdominal malignancies (2 neuroendocrine tumors, 2 gastrointestinal stromal tumors, 1 desmoid tumor, and 1 low-grade sarcoma). All patients survived the procedure. One patient died of pancytopenia 2 months after transplantation and another died with pulmonary emboli at 4 months. The remaining 4 patients are alive without any evidence of disease recurrence.
Although large intra-abdominal desmoid tumors, well-differentiated neuroendocrine tumors, and gastrointestinal stromal tumors are slow growing, they tend to invade locally, especially to the mesenteric root and/or celiac axis and other abdominal viscera. Complete resection followed by multivisceral transplantation could be a therapeutic option for these advanced tumors.
一些腹内或腹膜后肿瘤，如低度缓慢生长的恶性肿瘤，由于主要血管受侵或存在腹内播散，看似无法切除，但患者缓慢的生长速度以及在一定程度上较长的预期寿命促使我们寻找一些策略来治愈患者，或至少实现肿瘤缓解或症状减轻。整块切除，随后进行多脏器或保留肝脏的“改良”多脏器移植，最近已被用于治疗这些患者。
2010年5月至2012年10月期间，对6例（年龄14至55岁；平均32岁）患有一些缓慢生长的腹内恶性肿瘤（2例神经内分泌肿瘤、2例胃肠道间质瘤、1例硬纤维瘤和1例低度肉瘤）的患者进行了3例多脏器移植和3例改良多脏器移植。所有患者手术均存活。1例患者移植后2个月死于全血细胞减少，另1例在4个月时死于肺栓塞。其余4例患者存活，无疾病复发迹象。
尽管腹内巨大硬纤维瘤、高分化神经内分泌肿瘤和胃肠道间质瘤生长缓慢，但它们倾向于局部侵犯，尤其是侵犯肠系膜根部和/或腹腔干以及其他腹部脏器。完整切除后进行多脏器移植可能是这些晚期肿瘤的一种治疗选择。
