Ex Vivo Resection and Autotransplantation for Conventionally Unresectable Tumors - An 11-year Single Center Experience
| Autor: | Joshua Weiner, Peter Liou, Karim J. Halazun, Gary K. Schwartz, Benjamin Samstein, Regina Hwang, Abhishek Mathur, Tomoaki Kato, Daniel Cherqui, Adam Griesemer, Jean C. Emond |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent medicine.medical_treatment Single Center Transplantation Autologous Sepsis 03 medical and health sciences 0302 clinical medicine Postoperative Complications medicine Carcinoma Humans Child Digestive System Surgical Procedures Aged Gastrointestinal Neoplasms Retrospective Studies business.industry Perioperative Middle Aged medicine.disease Autotransplantation Surgery Survival Rate 030220 oncology & carcinogenesis Child Preschool 030211 gastroenterology & hepatology Female Sarcoma Hepatectomy business Ex vivo |
| Zdroj: | Annals of surgery. 272(5) |
| ISSN: | 1528-1140 |
| Popis: | Background and aims Ex vivo surgery may provide a chance at R0 resection for conventionally unresectable tumors. However, long-term outcomes have not been well documented. In this study, we analyze our 11-year outcomes to define its role. Study design We retrospectively analyzed 46 consecutive patients who underwent ex vivo surgery at our institution 2008-2019. Results The types of tumors were: carcinoma (n = 20), sarcoma (n = 20) and benign to low grade tumor (n = 6). The type of ex vivo surgery was chosen based on tumor location and vascular involvement. The most commonly performed procedure was ex vivo hepatectomy (n = 18), followed by ex vivo resection and intestinal autotransplantation (n = 12), ex vivo Whipple procedure and liver autotransplantation (n = 8) and multivisceral ex vivo procedure (n = 7). Twenty-three patients (50%) are currently alive with median follow-up of 4.0-years (11 months-11.8 years). The overall survival was 70%/59%/52%, at 1-/3-/5-years, respectively. Patient survival for benign to low grade tumors, sarcoma, and carcinoma was 100%/100%/100%, 65%/60%/50%, and 65%/45%/40%, at 1-/3-/5-years, respectively. Ninety-one percent patients had R0 resection, and 57% had no recurrence to date with median follow-up of 3.1-years. Two patients (4.3%) died within 30 days due to sepsis and gastroduodenal artety (GDA) stump blowout. Two additional patients died between 30 and 90 days due to sepsis. Perioperative mortality in the last 23 consecutive cases was limited to 1 patient who died of sepsis between 30 and 90 days. Conclusions For a selected group of patients with conventionally unresectable tumors, ex vivo surgery can offer effective surgical removal with a reasonably low perioperative mortality at experienced centers. |
| Databáze: | OpenAIRE |
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