ASSESSMENT OF 5-YEAR EXPERIENCE WITH ABDOMINAL ORGAN CLUSTER TRANSPLANTATION

BACKGROUND: Upper abdominal exenteration (resection of the liver, stom ach, spleen, pancreaticoduodenal complex, and part of the colon) for t he treatment of otherwise unresectable tumors is one of the more radic al operations in oncology. This study was done to analyze retrospectiv ely a five-year experience with exenteration in 57 patients treated wi th variations of resectional and transplant reconstructive techniques. STUDY DESIGN: Sixty-one transplantations were performed upon 57 patie nts. Three different organ replacement techniques were used: liver-pan creas-duodenum en bloc (original procedure), liver only (modified proc edure), and liver plus pancreatic islets. The diagnoses were cholangio carcinoma (20 patients), hepatocellular carcinoma (12 patients), endoc rine neoplasms (14 patients), sarcoma (six patients), and adenocarcino ma of the pancreas (two patients), colon (two patients), or gallbladde r (one patient). Analyses of survival and tumor recurrence were strati fied by procedure variations, type and extent of tumor, and immunosupp ressive regimen. RESULTS: The three month and one, two, three, and fiv e year actuarial patient survival rates were 82, 56, 38, 33, and 30 pe rcent, respectively. Eighteen (31.5 percent) of the 57 patients are al ive after 425 15 (standard deviation) months (range of 17 to 61 months ) and 12 patients are tumor free. The actuarial survival rates stratif ied by transplantation procedure, immunosuppression, and tumor diagnos is and extent showed no statistically significant differences beyond t he three different transplantation groups. Endocrine tumors had a bett er three-year survival rate (64 percent) than sarcoma (44 percent), he patocellular carcinoma (25 percent), cholangiocarcinoma (20 percent), and the other adenocarcinomas (20 percent). Twenty-three patients (40 percent) died as a result of tumor recurrence. Patients with combined factors of no lymph node involvement, absence of vascular invasion, an d metastases to the liver only (11 patients) had the lowest incidence of recurrence (27 compared to 73.5 percent, p=0.006). CONCLUSIONS: Pat ients with unresectable endocrine neoplasms, fibrolamellar hepatocellu lar carcinoma, and selected cholangiocarcinoma confined to the liver c an benefit from this radical operative approach. Patients with sarcoma can achieve long survival periods but have a high recurrence rate.