Nutritional Challenges in Patients After Intestinal Autotransplantation and Ex Vivo Surgery

BACKGROUND: Intestinal autotransplantation (IATx) and ex vivo resection is a novel surgical strategy to treat patients with unresectable abdominal neoplasms involving the mesenteric root. Nutritional challenges after IATx and ex vivo surgery have not been well described. METHODS: Eleven patients, aged 7-68 years (median, 49 years) underwent IATx and ex vivo resection at our center from 2009 to 2016. A retrospective chart review was performed to evaluate nutrition status, tolerance of an oral diet, and need for parenteral nutrition (PN) and enteral (EN) nutrition. These factors were assessed preoperatively and at 3 months postoperatively. RESULTS: Prior to surgery, 10 of 11 patients were tolerating oral diets without need for additional PN or EN. Postoperatively, PN was initiated in all patients from 1-15 days after surgery (median, 5 days) and continued from 12-122 days (median, 32.5 days), except for of 1 patient who underwent a total enterectomy and required subsequent allotransplantation with ongoing PN. EN was initiated in 9 patients from 4-117 days after surgery (median, 17 days) and has been ongoing in 5 patients. Oral diets were initiated in all patients from 5-115 days (median, 14 days) postoperatively; at 3 months, 11 of 12 patients were tolerating oral diets. CONCLUSION: IATx and ex vivo resection presents a unique challenge with respect to nutrition management. Patients undergoing these complex surgeries may have difficulty maintaining adequate nutrition with an oral diet alone in the immediate postoperative period and beyond and may require prolonged nutrition support.