Modified semi-<i>ex vivo</i> small intestinal autotransplantation for cholangiocarcinoma with mesenteric root invasion：a case report_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YOU Xinyu , PANG Beichuan , ZUO Bangyou , JIANG Jipeng , CHENG Donghui , YANG Chong , HAO Jianjie , LIU Tao ,  ZHANG Yu

Affiliated Hospital of University of Electronic Science and Technology of China • Department of Hepatobiliary and Pancreatic Surgery, Sichuan Provincial People’s Hospital, Chengdu 610072, P. R. China;

Corresponding author：

ZHANG Yu, Email: zhangyuqg@med.uestc.edu.cn

Keywords：

distal cholangiocarcinoma; small intestinal autotransplantation; superior mesenteric artery

DOI：

10.7507/1007-9424.202304008

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To explore the feasibility and safety of modified semi-ex vivo small intestinal autotransplantation (IAT) in patients with distal cholangiocarcinoma (CC) involving mesenteric root. Method The clinicopathologic data of the patient with relapse after CC surgery admitted to Sichuan Provincial People’s Hospital on October 2022 were retrospectively analyzed. Results The patient was a 40 years old male. The preoperative imaging showed that the superior mesenteric artery (SMA) and jejunal artery was surrounded by the tumor. The preoperative condition was good and the heart, lung, liver, and kidney functions were normal. The patient could tolerate surgery, then the modified semi-ex vivo IAT was performed. The patient recovered well after surgery and discharged on the 14th postoperative day. The postoperative pathological diagnosis result showed that it was CC. The patient was well and without recurrence or metastasis during following-up in the outpatient service for 5 months until April 2023. Conclusions From the retrospective analysis of this case, it can be realized that the modified semi-ex vivo IAT for patients with tumor involving themesenteric root, it is safe and feasible. A treatment option can be provided for such patient.

Citation： YOU Xinyu, PANG Beichuan, ZUO Bangyou, JIANG Jipeng, CHENG Donghui, YANG Chong, HAO Jianjie, LIU Tao, ZHANG Yu. Modified semi-ex vivo small intestinal autotransplantation for cholangiocarcinoma with mesenteric root invasion：a case report. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2023, 30(7): 777-781. doi: 10.7507/1007-9424.202304008 Copy

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2.	Gemici K, Buldu İ, Acar T, et al. Management of patients with retroperitoneal tumors and a review of the literature. World J Surg Oncol, 2015, 13: 143. doi: 12957-015-0548-z.
3.	Tseng JF, Raut CP, Lee JE, et al. Pancreaticoduodenectomy with vascular resection: margin status and survival duration. J Gastrointest Surg, 2004, 8(8): 935-949.
4.	Lai DT, Chu KM, Thompson JF, et al. Islet cell carcinoma treated by induction regional chemotherapy and radical total pancreatectomy with liver revascularization and small bowel autotransplantation. Surgery, 1996, 119(1): 112-114.
5.	Tzakis AG, De Faria W, Angelis M, et al. Partial abdominal exenteration, ex vivo resection of a large mesenteric fibroma, and successful orthotopic intestinal autotransplantation. Surgery, 2000, 128(3): 486-489.
6.	Lu DS, Reber HA, Krasny RM, et al. Local staging of pancreatic cancer: criteria for unresectability of major vessels as revealed by pancreatic-phase, thin-section helical CT. AJR Am J Roentgenol, 1997, 168(6): 1439-1443.
7.	Liang T, Zhang Q, Wu G, et al. Radical resection combined with intestinal autotransplantation for locally advanced pancreatic cancer after neoadjuvant therapy: a report of 36 consecutive cases. Ann Surg, 2023 Jan 24. doi: 10.1097/SLA.0000000000005797.
8.	Quintini C, Di Benedetto F, Diago T, et al. Intestinal autotrans-plantation for adenocarcinoma of pancreas involving the mesenteric root: our experience and literature review. Pancreas, 2007, 34(2): 266-268.
9.	Tzakis AG, Kato T, Mittal N, et al. Intestinal autotransplantation for the treatment of pathologic lesions at the root of the mesentery. Transplant Proc, 2002, 34(3): 908-909.
10.	Tzakis AG, Tryphonopoulos P, De Faria W, et al. Partial abdominal evisceration, ex vivo resection, and intestinal autotransplantation for the treatment of pathologic lesions of the root of the mesentery. J Am Coll Surg, 2003, 197(5): 770-776.
11.	吴国生, 梁廷波. 自体小肠移植技术的实践与挑战. 中华消化外科杂志, 2021, 20(1): 85-88.
12.	Massironi S, Cavalcoli F, Rausa E, et al. Understanding short bowel syndrome: current status and future perspectives. Dig Liver Dis, 2020, 52(3): 253-261.
13.	Pironi L. Definitions of intestinal failure and the short bowel syndrome. Best Pract Res Clin Gastroenterol, 2016, 30(2): 173-185.
14.	Nikeghbalian S, Aliakbarian M, Kazemi K, et al. Ex-vivo resection and small-bowel auto-transplantation for the treatment of tumors at the root of the mesentery. Int J Organ Transplant Med, 2014, 5(3): 120-124.
15.	Chan DKH, Lee SKF, Ang JJ. Indocyanine green fluorescence angiography decreases the risk of colorectal anastomotic leakage: Systematic review and meta-analysis. Surgery, 2020, 168(6): 1128-1137.
16.	Alemanno G, Somigli R, Prosperi P, et al. Combination of diagnostic laparoscopy and intraoperative indocyanine green fluorescence angiography for the early detection of intestinal ischemia not detectable at CT scan. Int J Surg Case Rep, 2016, 26: 77-80.

1. Dufay C, Abdelli A, Le Pennec V, et al. Mesenteric tumors: diagnosis and treatment. J Visc Surg, 2012, 149(4): e239-e251. doi: 10.1016/j.jviscsurg.2012.05.005.
2. Gemici K, Buldu İ, Acar T, et al. Management of patients with retroperitoneal tumors and a review of the literature. World J Surg Oncol, 2015, 13: 143. doi: 12957-015-0548-z.
3. Tseng JF, Raut CP, Lee JE, et al. Pancreaticoduodenectomy with vascular resection: margin status and survival duration. J Gastrointest Surg, 2004, 8(8): 935-949.
4. Lai DT, Chu KM, Thompson JF, et al. Islet cell carcinoma treated by induction regional chemotherapy and radical total pancreatectomy with liver revascularization and small bowel autotransplantation. Surgery, 1996, 119(1): 112-114.
5. Tzakis AG, De Faria W, Angelis M, et al. Partial abdominal exenteration, ex vivo resection of a large mesenteric fibroma, and successful orthotopic intestinal autotransplantation. Surgery, 2000, 128(3): 486-489.
6. Lu DS, Reber HA, Krasny RM, et al. Local staging of pancreatic cancer: criteria for unresectability of major vessels as revealed by pancreatic-phase, thin-section helical CT. AJR Am J Roentgenol, 1997, 168(6): 1439-1443.
7. Liang T, Zhang Q, Wu G, et al. Radical resection combined with intestinal autotransplantation for locally advanced pancreatic cancer after neoadjuvant therapy: a report of 36 consecutive cases. Ann Surg, 2023 Jan 24. doi: 10.1097/SLA.0000000000005797.
8. Quintini C, Di Benedetto F, Diago T, et al. Intestinal autotrans-plantation for adenocarcinoma of pancreas involving the mesenteric root: our experience and literature review. Pancreas, 2007, 34(2): 266-268.
9. Tzakis AG, Kato T, Mittal N, et al. Intestinal autotransplantation for the treatment of pathologic lesions at the root of the mesentery. Transplant Proc, 2002, 34(3): 908-909.
10. Tzakis AG, Tryphonopoulos P, De Faria W, et al. Partial abdominal evisceration, ex vivo resection, and intestinal autotransplantation for the treatment of pathologic lesions of the root of the mesentery. J Am Coll Surg, 2003, 197(5): 770-776.
11. 吴国生, 梁廷波. 自体小肠移植技术的实践与挑战. 中华消化外科杂志, 2021, 20(1): 85-88.
12. Massironi S, Cavalcoli F, Rausa E, et al. Understanding short bowel syndrome: current status and future perspectives. Dig Liver Dis, 2020, 52(3): 253-261.
13. Pironi L. Definitions of intestinal failure and the short bowel syndrome. Best Pract Res Clin Gastroenterol, 2016, 30(2): 173-185.
14. Nikeghbalian S, Aliakbarian M, Kazemi K, et al. Ex-vivo resection and small-bowel auto-transplantation for the treatment of tumors at the root of the mesentery. Int J Organ Transplant Med, 2014, 5(3): 120-124.
15. Chan DKH, Lee SKF, Ang JJ. Indocyanine green fluorescence angiography decreases the risk of colorectal anastomotic leakage: Systematic review and meta-analysis. Surgery, 2020, 168(6): 1128-1137.
16. Alemanno G, Somigli R, Prosperi P, et al. Combination of diagnostic laparoscopy and intraoperative indocyanine green fluorescence angiography for the early detection of intestinal ischemia not detectable at CT scan. Int J Surg Case Rep, 2016, 26: 77-80.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Modified semi-ex vivo small intestinal autotransplantation for cholangiocarcinoma with mesenteric root invasion：a case report

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