Wu Guosheng
Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, Xi'an, Shaanxi, China.
Gastroenterol Rep (Oxf). 2017 Nov;5(4):258-265. doi: 10.1093/gastro/gox027. Epub 2017 Jul 17.
Most abdominal neoplasms involving the root of the superior mesenteric artery and/or celiac artery are difficult to manage with conventional operative techniques because of limited intestinal ischemia times and poor accessibility to the tumor region. surgery followed by intestinal autotransplantation (IATx) is a relatively novel surgical strategy to offer chances for complete resection in such hopeless circumstances. This review aims to assess potential surgical indications, operative techniques and clinical outcomes after IATx. Currently the main indications reported for IATx broadly include pancreatic, mesenteric and retroperitoneal neoplasms closely involving the superior mesenteric vessels. The preliminary results show that radical resection can be effectively achieved in carefully selective patients. Although perioperative morbidity and mortality are relatively high, there are several long-term survivors, particularly after complete resection of benign and low-grade tumor. Early tumor recurrence, however, remains a major problem in patients with high-grade tumor, particularly pancreatic ductal carcinoma. In conclusion, IATx allows patients with selected abdominal neoplasms involving the major mesenteric vessels to be completely resected. However, this aggressive approach is associated with a considerable operative risk, and should only be performed at experienced centers. Additional and adjunctive treatment therapies are required to improve the efficacy of this treatment.
大多数累及肠系膜上动脉根部和/或腹腔动脉的腹部肿瘤，由于肠道缺血时间有限且肿瘤区域难以接近，采用传统手术技术难以处理。手术联合肠道自体移植（IATx）是一种相对新颖的手术策略，在此类绝望情况下为实现完整切除提供机会。本综述旨在评估IATx后的潜在手术适应症、手术技术和临床结果。目前报道的IATx主要适应症广泛包括紧密累及肠系膜上血管的胰腺、肠系膜和腹膜后肿瘤。初步结果表明，在经过仔细挑选的患者中可以有效实现根治性切除。虽然围手术期发病率和死亡率相对较高，但有几位长期存活者，特别是在完全切除良性和低级别肿瘤后。然而，早期肿瘤复发仍然是高级别肿瘤患者的主要问题，尤其是胰腺导管癌。总之，IATx使累及主要肠系膜血管的特定腹部肿瘤患者能够被完整切除。然而，这种激进的方法伴随着相当大的手术风险，并且应该仅在经验丰富的中心进行。需要额外的辅助治疗方法来提高这种治疗的疗效。
