Objective: 

We herein advocate for more extensive utilization of ex vivo resection techniques for otherwise unresectable liver tumors by presenting the largest collective American experience.

Background: 

Advanced in situ resection and vascular reconstruction techniques have made R0 resection possible for otherwise unresectable liver tumors. Ex vivo liver resection may further expand the limits of resectability but remains underutilized due to concerns about technical complexity and vascular thrombosis. However, we believe that the skillset required for ex vivo liver resection is more widespread and the complications less severe than widely assumed, making ex vivo resection a more attractive option in selected case.

Methods: 

We retrospectively analyzed 35 cases performed by surgical teams experienced with ex vivo liver resections (at least 4 cases) between 1997 and 2021.

Results: 

We categorized malignancies as highly aggressive (n=18), moderately aggressive (n=14), and low grade (n=3). All patients underwent total hepatectomy, vascular reconstruction and resection in hypothermia on the backtable, and partial liver autotransplantation. Overall survival was 67%/39%/28%, at 1/3/5 years, respectively, with a median survival of 710 days (range: 22–4824). Patient survival for highly aggressive, moderately aggressive, and low-grade tumors was 61%/33%/23%, 67%/40%/22%, and 100%/100%/100% at 1/3/5 years, respectively, with median survival 577 days (range: 22–3873), 444 days (range: 22–4824), and 1825 days (range: 868–3549).

Conclusions: 

Ex vivo resection utilizes techniques commonly practiced in partial liver transplantation, and we demonstrate relatively favorable outcomes in our large collective experience. Therefore, we propose that more liberal use of this technique may benefit selected patients in centers experienced with partial liver transplantation.

中文翻译：

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离体肝切除和自体移植：应该更频繁地使用吗？

客观的： 

我们在此倡导通过展示美国最大的集体经验，更广泛地利用体外切除技术来治疗原本无法切除的肝肿瘤。

背景： 

先进的原位切除和血管重建技术使 R0 切除成为可能，用于其他无法切除的肝脏肿瘤。离体肝切除术可能会进一步扩大可切除性的范围，但由于担心技术复杂性和血管血栓形成而仍未得到充分利用。然而，我们认为离体肝切除术所需的技能更广泛，并发症也没有人们普遍认为的那么严重，这使得离体肝切除术在特定病例中成为更具吸引力的选择。

方法： 

我们回顾性分析了 1997 年至 2021 年间由经历过体外肝切除术的外科团队实施的 35 例（至少 4 例）。

结果： 

我们将恶性肿瘤分为高度侵袭性（n=18）、中度侵袭性（n=14）和低度（n=3）。所有患者均接受了全肝切除、血管重建和后台低温切除以及部分自体肝移植。总生存期分别为 67%/39%/28%，分别为 1/3/5 年，中位生存期为 710 天（范围：22-4824）。1/3/5 年高度侵袭性、中度侵袭性和低级别肿瘤的患者生存率为 61%/33%/23%、67%/40%/22% 和 100%/100%/100%，中位生存期分别为 577 天（范围：22-3873）、444 天（范围：22-4824）和 1825 天（范围：868-3549）。

结论： 

离体切除利用了部分肝移植中常用的技术，我们在大量的集体经验中证明了相对有利的结果。因此，我们建议更自由地使用这种技术可能会使有部分肝移植经验的中心的选定患者受益。