Radical Resection Combined With Intestinal Autotransplantation for Locally Advanced Pancreatic Cancer After Neoadjuvant Therapy

作者：Tingbo Liang, Qi Zhang, Guosheng Wu, Chaoxu Liu, Xueli Bai, Shunliang Gao, Tao Ma, Ke Sun, Senxiang Yan, Wenbo Xiao, Tianan Jiang, FangYan Lu, Yuntao Zhang, Yan Shen, Min Zhang, Xiaochen Zhang, Jianzhen Shan · 发表于：Annals of Surgery · 年份：2023 · DOI：10.1097/sla.0000000000005797 · 被引用次数：21 · 研究领域：Pancreatic and Hepatic Oncology Research、Cancer Research and Treatments、Cancer Cells and Metastasis

OBJECTIVE: To achieve radical resection of locally advanced pancreatic ductal adenocarcinoma (PDAC), and tested the safety and benefits of intestinal autotransplantation in pancreatic surgery. BACKGROUND: PDAC has an extremely dismal prognosis. Radical resection was proved to improve the prognosis of patients with PDAC; however, the locally advanced disease had a very low resection rate currently. We explored and evaluated whether the combination of modern advances in systemic treatment and this macroinvasive surgery was feasible in clinical practice. METHODS: Patients diagnosed as PDAC with superior mesenteric artery involvement and with or without celiac trunk involvement were included. Patients were treated with modified-FOLFIRINOX chemotherapy with or without anti-PD-1 antibodies and were applied to tumor resection combined with intestinal autotransplantation. Data on operative parameters, pathologic results, mortality, morbidity, and survival were analyzed. RESULTS: A total of 36 consecutive cases were applied to this strategy and underwent radical resection combined with intestinal autotransplantation. Among these patients, 24 of them received the Whipple procedure, 11 patients received total pancreatectomy, and the other 1 patient received distal pancreatectomy. The median operation time was 539 minutes. Postoperative pathology showed an R0 resection rate of 94.4%, and tumor invasion of a superior mesenteric artery or superior mesenteric vein was confirmed in 32 patien...