Ex Vivo Resection and Intestinal Autotransplantation

OBJECTIVE: To evaluate the perioperative and long-term outcomes of ex vivo resection and intestinal autotransplantation (ERIA) for tumors. SUMMARY OF BACKGROUND DATA: ERIA could offer effective therapy for tumors considered unresectable by conventional methods. However, there has been limited data of ERIA. To our knowledge, this represents the largest case series of ERIA to date. METHODS: We conducted an international multicenter retrospective data analysis of patients who underwent ERIA with or without Whipple procedure at 5 institutions between 1999 and 2024. Cases that required liver autotransplantation were excluded. RESULTS: A total of 35 patients (25 with Whipple procedures) were analyzed. We classified tumors as highly malignant (n=16) and benign/low-grade (n=19). The highly malignant group included 7 pancreatic adenocarcinomas and 5 sarcomas, while the low-grade group included 9 desmoid tumors. The median tumor size was 11.1 cm (4.5-30.0 cm) and R0 resection was achieved in 85.7%. There was no 90-day mortality. The overall 1-, 3-, and 5-year survivals were 87.7, 70.3, and 66.2%, respectively. The 1, 3, and 5 year overall survival (OS) and recurrence-free survival (RFS) for the highly malignant group were 72.2%, 32.5%, and 32.5% and 66.7%, 20.0%, and 13.3%, respectively. The 1, 3, and 5 year OS and RFS for the benign to low-grade tumors were 100%, 100%, and 92.9% and 100%, 93.3%, and 86.7%, respectively. CONCLUSIONS: ERIA can be performed with low perioperative mortality and acceptable outcomes in select patients with otherwise unresectable tumors.