Abstract: Intestinal autotransplantation (IATx) has emerged as a novel surgical strategy to achieve curative resection in patients with locally advanced pancreatic cancer (LAPC) involving complex vascular invasion of the mesenteric root.With advances in neoadjuvant therapy, organ-preserving techniques, vascular reconstruction, and hypothermic perfusion, IATx has gradually overcome the technical barriers that traditionally rendered these tumors unresectable, thereby improving the likelihood of R0 resection and enhancing long-term survival outcomes.Based on the latest domestic and international evidence, together with our institutional experience, this review systematically summarizes the indications for IATx in LAPC, patient selection following neoadjuvant therapy, individualized surgical planning, and the application of modified techniques such as in situ cold perfusion.In addition, the advantages of IATx in damage control, organ function preservation, and perioperative management are discussed.Current challenges, including optimal patient selection, perioperative risk management, long-term outcome evaluation, and future directions, are also addressed.As precision surgery, multidisciplinary team (MDT) management, and multimodal treatment strategies continue to evolve, IATx and its modified approaches are expected to further expand the indications for curative resection in patients with LAPC and other complex tumors involving the mesenteric root, ultimately leading to improved long-term prognosis.

Key words: intestinal autotransplantation, pancreatic cancer, locally advanced, radical resection