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ex vivo liver resection and auto-transplantation as an alternative for the treatment of liver malignancies: Progress and challenges

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Hepatobiliary & Pancreatic Diseases International 2024年第2期23卷 117-122页

作者： Xin Yang Lu Lu Wen-Wei Zhu Yi-Feng Tao Cong-Huan Shen Jin-Hong Chen Zheng-Xin Wang Lun-Xiu Qin Hepatobiliary Surgery and liver Transplantation Centers Department of General SurgeryHuashan Hospital&Cancer Metastasis InstituteFudan UniversityShanghai 200040China

Hepatectomy is still the major curative treatment for patients with liver ***,it is still a big challenge to remove the tumors in the central posterior area,especially if their location involves the retrohepatic inferior vena cava and hepatic *** vivo liver resection and auto-transplantation(ELRA),a hybrid technique of the traditional liver resection and transplantation,has brought new hope to these patients and therefore becomes a valid alternative to liver *** to its technical difficulty,ELRA is still concentrated in a few hepatobiliary centers that have experienced surgeons in both liver resection and liver *** efficacy and safety of this technique has already been demonstrated in the treatment of benign liver diseases,especially in the advanced alveolar ***,the application of ELRA for liver malignances has gained more ***,standardization of clinical practice norms and international consensus are still *** prognostic impact in these oncologic patients also needs further *** this review,we summarized the principles and recent progresses on ELRA.

关键词： ex vivo liver resection liver auto-transplantation Oncology liver malignancies

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ex vivo liver resection followed by autotransplantation for end-stage hepatic alveolar echinococcosis

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Chinese Medical Journal 2011年第18期124卷 2813-2817页

作者： WEN Hao DONG Jia-hong ZHANG Jin-hui ZHAO Jin-ming SHAO Ying-mei DUAN Wei-dong LIANG Yu-rong JI Xue-wen TAI Qin-wen Tuerganali Aji LI Tao State Key Lab Breeding Base of Xinjiang Major Disease Research and Department of liver and Laparoscopic Surgery First Affiliated Hospital of Xinjiang Medical University Xinjiang Organ Transplantation Research Institute Urumqi Xinjiang 830054 China Department of Hepatobiliary Surgery General Hospital of People'sLiberation Army Beijing 100853 China

Background For patients with end-stage hepatic alveolar echinococcosis （AE）, in vivo resection of the involved parts of the liver is usually very difficult, therefore, allogenic liver transplantation is indicated. However, we hypothesize that for selected patents, ex vivo liver resection for thorough elimination of the involved tissues and liver autotransplantation may offer a chance for clinical cure. Methods We presented a 24-year-old women with a giant hepatic AE lesion who was treated with hepatectomy, ex vivo resection of the involved tissue and hepatic autotransplantation. The patient had moderate jaundice and advanced hepatic AE lesion which involved segments I, IV, V, VI, VII, VIII and retrohepatic inferior vena cava. The lateral segments （II and III） of the left liver remained normal with over 1000 ml in its volume. No extrahepatic metastases （such as to the lung or brain） could be found. As the first step of treatment, X-ray guided percutaneous transhepatic cholangiodrainage （PTCD） was performed twice for bile drainage in segment III and II separately until her serum total bilirubin decreased gradually from 236 to 88 umol/L. Total liver resection was then performed, followed by extended right hepatic trisegmentectomy and the entire retrohepatic vena cava was surgically removed en bloc while her hemodynamics parameters were stable. Neither veino-veinous bypass nor temporary intracorporeal cavo-caval or porto-caval shunt was used during the 5.7-hour anhepatic phase. The remained AE-free lateral segments of the-left liver were re-implanted in situ. The left hepatic vein was directly anastomosed end-to-end to the suprahepatic inferior vena cava due to the lack of the retrohepatic inferior vena cava with AE total infiltration. Because compensatory retroperitoneal porto-caval collateral circulation developed, we enclosed remained infrahepatic inferior vena cava at renal vein level without any haemodynamics problems. Results During a 60-day following-up after ope

关键词： liver autotransplantation alveolar echinococcosis ex vivo liver resection liposomal albendazole

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ex vivo liver resection followed by autotransplantation in radical resection of gastric cancer liver metastases:A case report

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World Journal of Clinical Cases 2021年第17期9卷 4221-4229页

作者： Hong Wang Cheng-Cheng Zhang Yan-Jiao Ou Lei-Da Zhang Southwest Hospital Third Military Medical University(Army Medical University)Institute of Hepatobiliary SurgeryChongqing 400038China

BACKGROUND Radical resection of gastric cancer liver metastases(GCLM)can increase the 5-year survival rate of GCLM ***,patients may lose the theoretical feasibility of surgery due to the critical location of liver metastasis in some *** SUMMARY A 29-year-old woman had a chief complaint of chronic abdominal pain for 1 *** computed tomography and magnetic resonance imaging examinations suggested a mass of unknown pathological nature located between the first and second hila and the margin of the lower segment of the right lobe of the *** anterior wall of the gastric antrum was unevenly *** diagnosis of(gastric antrum)intramucosal well-differentiated adenocarcinoma was histopathologically confirmed by puncture biopsy with gastroscopy *** underwent radical resection(excision of both gastric tumors and ex vivo liver resection followed by autotransplantation simultaneously)followed by XELOX adjuvant *** serious postoperative complications,the patient was successfully discharged on the 20th day after the *** examination of the excised specimen indicated that gastrectomy with D2 lymph node dissection for primary gastric tumors and R0 resection for liver metastases were *** resected mass was confirmed to be poorly differentiated gastric carcinoma(hepatoid adenocarcinoma with neuroendocrine differentiation)with liver metastases in segments *** recurrence or metastasis within the liver was found during a 7.5-year follow-up review that began 1 mo after *** Application of ex vivo liver resection followed by autotransplantation in radical resection for GCLM can help selected patients with intrahepatic metastases located in complex sites obtain a favorable clinical outcome.

关键词： ex vivo liver resection Autotransplantation Gastric cancer liver metastases Critical location Selected patients Radical resection Case report

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Approaches to reconstruction of inferior vena cava by ex vivo liver resection and autotransplantation in 114 patients with hepatic alveolar echinococcosis

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World Journal of Gastroenterology 2022年第31期28卷 4351-4362页

作者： Yusufukadier Maimaitinijiati Tuerganaili AJi Tie-Min Jiang Bo Ran Ying-Mei Shao Rui-Qing Zhang Qiang Guo Mao-Lin Wang Hao Wen State Key Laboratory on Pathogenesis Prevention and Treatment of High Incidence Diseases in Central AsiaThe First Clinical CollegeXinjiang Medical UniversityUrumqi 830011Xinjiang Uygur Autonomous RegionChina Department of Hepatobiliary Surgery The First Affiliated Hospital of Xinjiang Medical UniversityUrumqi 830011Xinjiang Uygur Autonomous RegionChina Xinjiang Organ Transplant Institution The First Affiliated Hospital of Xinjiang Medical UniversityUrumqi 830011Xinjiang Uygur Autonomous RegionChina

BACKGROUND Hepatic alveolar echinococcosis(AE)is most commonly found in retrohepatic inferior vena cava(RHIVC).ex vivo liver resection and autotransplantation(ELRA)can better realize the radical resection of end-stage hepatic AE with severely compromised hepatocaval confluences,and reconstruction of the affected ***,there is a scarcity of information regarding RHIVC reconstruction in *** To propose reasonable RHICV reconstruction strategies for ex vivo liver resection and *** We retrospectively summarized the clinical data of 114 patients diagnosed with hepatic AE who treated by ELRA in our department.A total of 114 patients were divided into three groups according to the different reconstruction methods of RHIVC:Group A with original RHIVC being repaired and reconstructed(n=64),group B with RHIVC being replaced(n=43),and group C with RHIVC being resected without reconstruction(n=7).The clinical data of patients,including the operation time,anhepatic phase,intraoperative blood loss,complications and postoperative hospital stay,were analyzed and the patients were routinely followed *** normally distributed continuous variables were expressed as means±SD,whereas the abnormally distributed ones were expressed as median and analyzed by analysis of *** curve was plotted by the Kaplan-Meier *** All patients were routinely followed up for a median duration of 52(range,12-125)*** 30 d mortality rate was 7.0%(8/114)and 7 patients died within 90 *** all subjects,the inferior vena cava(IVC)-related complication rates were 17.5%(11/63)in group A and 16.3%(7/43)in group *** stenosis was found in 12 patients(10.5%),whereas thrombus was formed in 6 patients(5.3%).Twenty-two patients had grade III or higher complications,with the complication rates being 17.2%,16.3%,and 57.1%in the three *** average postoperative hospital stay in the three groups was 32.3±19.8,26.7±18.2,and 51.3±29.4 d(P=0.03),re

关键词： ex vivo liver resection Alveolar echinococcosis Inferior vena cava Vascular reconstruction liver transplantation Artificial vessel

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