Intestinal autotransplantation for complex intra-abdominal diseases previously considered unresectable: a systematic...

Intestinal autotransplantation (IATx) facilitates radical resection for advanced intra-abdominal cancers involving major vessels, which were previously deemed unresectable. This study systematically reviewed and meta-analyzed its perioperative safety and mid-term survival outcomes.

A search of databases was conducted up to December 2025, adhering to PRISMA guidelines. Studies reporting outcomes of IATx were included in the review. A total of 12 studies involving 160 patients were reviewed, with meta-analysis performed on six studies comprising 122 patients, using random-effects models. Primary outcomes included the 3-year overall survival (OS) rate, 90-day mortality, major complications (Clavien-Dindo ≥ III), and R0 resection rates. Secondary outcomes involved cold ischemia time, operative time, and length of hospital stay. Study quality was assessed by using the MINORS criteria.

The pooled 3-year OS rate was 57.9% (95% CI, 34.1%-75.7%; 4 studies; I ² = 36.8%, P = 0.040). Analysis of perioperative outcomes from six studies (122 patients) revealed a pooled 90-day mortality of 6.6% (95% CI, 3.1%-13.5%; I ² = 0%), a major complication rate (Clavien-Dindo ≥ III) of 27.9% (95% CI, 12.9%-50.3%; I ² = 71.8%), and an R0 resection rate of 92.3% (95% CI, 84.3%-96.4%; I ² = 0%). The pooled mean cold ischemia time was 124 minutes (95% CI, 75-173 minutes; 5 studies; I ² = 98.9%), the operative time was 10.4 h (95% CI, 9.1-11.7 h; 6 studies; I ² = 90.4%), and the postoperative length of stay averaged 22 days (95% CI, 19-25 days; 5 studies; I ² = 35%).

IATx for unresectable complex intra-abdominal tumors demonstrates high R0 resection rates, low mortality, and encouraging 3-year OS outcomes. Given the procedural complexity, IATx should be performed exclusively at expert centers. Further long-term follow-up studies are necessary to validate these findings.