Auto-intestine transplant for Pancreatic Cancer.ppt

1. Auto-Intestine
Transplantation for
Locally advanced
Pancreatic Tumors
Involving Mesenteric Root
Dipesh Kumar Yadav (林山)
MD, PhD
Department of Hepatobiliary and Pancreatic Surgery
The First Affiliated Hospital of Zhejiang University

2. Disclosure Statement of
Financial Interest

3. • Background
• Aim
• Methods
• Results
• Conclusion
a) Cumulative overall survival of
pancreatic tumors.
b) Survival of patients with pancreatic
tumors undergoing aINTx according to
tumor type.
c) Survival of patients with pancreatic
tumors undergoing aINTx according to
neoadjuvant chemotherapy status.
d) Survival of patients with pancreatic
cancer (PC) undergoing aINTx
according to neoadjuvant chemotherapy
status.
e) Identification of prognostic factors.
f) Survival according to prognostic score.

4. • Background
• Aim
• Methods
• Results
• Conclusion
a) Cumulative overall survival of
pancreatic tumors.
b) Survival of patients with pancreatic
tumors undergoing aINTx according to
tumor type.
c) Survival of patients with pancreatic
tumors undergoing aINTx according to
neoadjuvant chemotherapy status.
d) Survival of patients with pancreatic
cancer (PC) undergoing aINTx
according to neoadjuvant chemotherapy
status.
e) Identification of prognostic factors.
f) Survival according to prognostic score.

5. Fig. Preoperative CT scan demonstrating pancreatic cancer involving the
mesenteric root and are unresectable by conventional surgical methods.
Patients with locally advanced pancreatic cancer
experience early recurrence as positive resection
margin rate remains high in about 22 to 63 % of the
cases after pancreatoduodenectomy.

6. • Two approaches -
In-vivo or Ex-vivo resection of a pancreatic
tumor and auto-intestinal autotransplantation (IATx)
as described by Lai et al. and Li et al. in 1996.
• Lai DT et al. Surgery 1996;119:112–14.
• Li CL et al. Zhonghua Wai Ke Za Zhi 1996;34:757.

8. • Background
• Aim
• Methods
• Results
• Conclusion
a) Cumulative overall survival of
pancreatic tumors.
b) Survival of patients with pancreatic
tumors undergoing aINTx according to
tumor type.
c) Survival of patients with pancreatic
tumors undergoing aINTx according to
neoadjuvant chemotherapy status.
d) Survival of patients with pancreatic
cancer (PC) undergoing aINTx
according to neoadjuvant chemotherapy
status.
e) Identification of prognostic factors.
f) Survival according to prognostic score.

9. • Long-term outcomes of auto-intestine transplantation
(aINTx) for locally invasive pancreatic tumors with
mesenteric root involvement are unknown.

10. • Background
• Aim
• Methods
• Results
• Conclusion
a) Cumulative overall survival of
pancreatic tumors.
b) Survival of patients with pancreatic
tumors undergoing aINTx according to
tumor type.
c) Survival of patients with pancreatic
tumors undergoing aINTx according to
neoadjuvant chemotherapy status.
d) Survival of patients with pancreatic
cancer (PC) undergoing aINTx
according to neoadjuvant chemotherapy
status.
e) Identification of prognostic factors.
f) Survival according to prognostic score.

11. • Databases were searched
for studies reporting
patients with locally
advanced pancreatic tumors
which underwent aINTx.
• We calculated patient
survival using the Kaplan-
Meier method and Cox
proportional hazard
regression analysis to
identify independent
predictors of survival.

12. • Background
• Aim
• Methods
• Results
• Conclusion
a) Cumulative overall survival of
pancreatic tumors.
b) Survival of patients with pancreatic
tumors undergoing aINTx according to
tumor type.
c) Survival of patients with pancreatic
tumors undergoing aINTx according to
neoadjuvant chemotherapy status.
d) Survival of patients with pancreatic
cancer (PC) undergoing aINTx
according to neoadjuvant chemotherapy
status.
e) Identification of prognostic factors.
f) Survival according to prognostic score.

13. Figure 1:
Cumulative
overall survival of
patients with
pancreatic tumors
after resection
and auto-
intestinal
transplant
(aINTx).
• Cumulative 1-, 3-, and 5-year overall
survival was 69.11%, 43.58%, and
43.58%, respectively.
• Median survival time= 30.2 months

14. • Background
• Aim
• Methods
• Results
• Conclusion
a) Cumulative overall survival of
pancreatic tumors.
b) Survival of patients with pancreatic
tumors undergoing aINTx according to
tumor type.
c) Survival of patients with pancreatic
tumors undergoing aINTx according to
neoadjuvant chemotherapy status.
d) Survival of patients with pancreatic
cancer (PC) undergoing aINTx
according to neoadjuvant chemotherapy
status.
e) Identification of prognostic factors.
f) Survival according to prognostic score.

15. • Figure 2A: Kaplan-
Meier cumulative
survival for patients
with pancreatic tumor
undergoing aINTx
according to tumor
types.
• 1-, 2- and 3-year survival rates for patients with
PC and benign or low grade pancreatic tumors
were 49.64%, 22.06% and 0% vs 100%, 100%
and 80%, respectively.
• Median survival times PC= 13.4 months and
Others = 84 months

16. • Background
• Aim
• Methods
• Results
• Conclusion
a) Cumulative overall survival of
pancreatic tumors.
b) Survival of patients with pancreatic
tumors undergoing aINTx according to
tumor type.
c) Survival of patients with pancreatic
tumors undergoing aINTx according to
neoadjuvant chemotherapy status.
d) Survival of patients with pancreatic
cancer (PC) undergoing aINTx
according to neoadjuvant chemotherapy
status.
e) Identification of prognostic factors.
f) Survival according to prognostic score.

17. • Figure 2B: Kaplan-
Meier cumulative
survival for patients
with pancreatic
tumor undergoing
aINTx according to
neoadjuvant
chemotherapy
status.
• 1-, 2- and 3-year survival rates for aINTx +
neoadjuvant chemotherapy and aINTx -
neoadjuvant chemotherapy were 83.33%,
83.33% and 83.33% vs 50.65%, 30.39 and
15.19%, respectively.
• The median survival times were 36 months
and 17 months, respectively.

18. • Background
• Aim
• Methods
• Results
• Conclusion
a) Cumulative overall survival of
pancreatic tumors.
b) Survival of patients with pancreatic
tumors undergoing aINTx according to
tumor type.
c) Survival of patients with pancreatic
tumors undergoing aINTx according to
neoadjuvant chemotherapy status.
d) Survival of patients with pancreatic
cancer (PC) undergoing aINTx
according to neoadjuvant chemotherapy
status.
e) Identification of prognostic factors.
f) Survival according to prognostic score.

19. • Figure 2C: Kaplan-
Meier cumulative
survival for patients
with pancreatic
cancer (PC)
undergoing aINTx
according to
neoadjuvant
chemotherapy status.
• 1- and 2-year survival rates for aINTx
+ neoadjuvant chemotherapy and
aINTx - neoadjuvant chemotherapy
were 75% and 75% vs 34.09% and
0%, respectively.
• Median survival time was 24 months
and 10 months, respectively.

20. • Background
• Aim
• Methods
• Results
• Conclusion
a) Cumulative overall survival of
pancreatic tumors.
b) Survival of patients with pancreatic
tumors undergoing aINTx according to
tumor type.
c) Survival of patients with pancreatic
tumors undergoing aINTx according to
neoadjuvant chemotherapy status.
d) Survival of patients with pancreatic
cancer (PC) undergoing aINTx
according to neoadjuvant chemotherapy
status.
e) Identification of prognostic factors.
f) Survival according to prognostic score.

21. Cox proportional hazard regression analyses of the
screened variables
Patients with PC (P = 0.021) and
patients that did not receive
neoadjuvant chemotherapy (P =
0.024) were significant independent
negative predictors of survival by
Cox proportional hazard regression
analysis

22. • Background
• Aim
• Methods
• Results
• Conclusion
a) Cumulative overall survival of
pancreatic tumors.
b) Survival of patients with pancreatic
tumors undergoing aINTx according to
tumor type.
c) Survival of patients with pancreatic
tumors undergoing aINTx according to
neoadjuvant chemotherapy status.
d) Survival of patients with pancreatic
cancer (PC) undergoing aINTx
according to neoadjuvant chemotherapy
status.
e) Identification of prognostic factors.
f) Survival according to prognostic score.

23. • Figure 3: Kaplan-
Meier cumulative
survival
according to
prognostic scores.
Using the log-rank test, we developed a scoring system based on the two previously
identified independent predictors of survival.
Score given: Patients with PC = 1 point, patients with other tumors (benign or low
grade tumors) = 0 point, aINTx + neoadjuvant chemotherapy = 0 point and aINTx -
neoadjuvant chemotherapy = 1 point.
This stratification delineated three separate population samples corresponding to
patients with scores of 0, 1 or 2.
The calculated 1-, 2- and 3-year survival for patients with scores of 0, 1 and 2 were
100%, 100% and 100%; 92.86%, 83.57% and 66.86%; and 22.73%, 0% and 0%,
respectively.

24. • Background
• Aim
• Methods
• Results
• Conclusion
a) Cumulative overall survival of
pancreatic tumors.
b) Survival of patients with pancreatic
tumors undergoing aINTx according to
tumor type.
c) Survival of patients with pancreatic
tumors undergoing aINTx according to
neoadjuvant chemotherapy status.
d) Survival of patients with pancreatic
cancer (PC) undergoing aINTx
according to neoadjuvant chemotherapy
status.
e) Identification of prognostic factors.
f) Survival according to prognostic score.

25. • This study suggests that aINTx is the best
curative option for patients with locally advanced
benign or low grade pancreatic tumors.
• There is a clinical benefit of giving neoadjuvant
chemotherapy prior to aINTx for patients with PC,
and thus neoadjuvant chemotherapy should be
considered in all PC patients with a good
performance score during an aINTx assessment.

26. • Lastly, ex-vivo/in situ resection of tumor followed
by aINTx approach seems to be feasible and
safe, which is worthy of popularization for
selected patients with locally invasive pancreatic
tumors that are otherwise unresectable by
conventional surgical techniques, it may offer
reasonable outcomes.