LAUSR

OBJECTIVE The aim of this study was 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 extremely dismal prognosis. Radical resection was proved to improve prognosis of patients with PDAC; however, 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 microinvasive surgery was feasible in clinical practice. METHODS Patients diagnosed as PDAC with superior mesenteric artery (SMA) involvement and with or without coeliac 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 of operative parameters, pathological 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 Whipple procedure, eleven patients received total pancreatectomy, and the other one patient received distal pancreatectomy. The median operation time was 539 minutes. Postoperative pathology showed R0 resection rate of 94.4%, and tumor invasion of SMA or SMV was confirmed in 32 patients. The median number of dissected lymph nodes was 43, and 25 patients were positive for lymph nodes metastasis. The median time of Intensive Care Unit stay was four days. Two patients died within 30 days after surgery due to multi-organ failure. The severe postoperative adverse events (equal or higher than grade 3) was observed in 12 out of 36 patients, and diarrhea, gastroparesis, and abdominal infection were the most frequent adverse events. Postoperative hospital stay was averagely 34 days. The recurrence-free survival is 13.6 months. The median overall survival of patients after diagnosis and after surgery were 21.4 months and 14.5 months, respectively. CONCLUSIONS Our attempt suggests safety of this modality and may be clinically beneficial for highly-selected patients with PDAC. However, experience of multidisciplinary pancreatic cancer care and intestinal transplantation is warranted.