Ex vivo liver resection and autotransplantation with cardiopulmonary bypass for hepatoblastoma in children: A case report

Abstract

Some primary and secondary liver carcinomas cannot be resected using a conventional approach due to their size, location, or major vascular invasion. The aim of this study was to explore the application of ex vivo liver resection and autotransplantation for complicated HB in children. A 1.5-year-old girl with HB after repeated chemotherapy was analyzed. In this patient, tumor invasion includes the IV, V, and VIII liver segments, and thrombosis formed in the inferior vena cava and right atrium. It is difficult to obtain complete tumor resection using conventional hepatectomy. The patient was treated via ex vivo liver resection and autotransplantation, and tumor thrombus in the inferior vena cava and right atrium was removed via cardiopulmonary bypass. Operative methods and precautions were analyzed during and after the operation. The operation was completed successfully within 8 hours, and the liver's cold ischemia time was 190 minutes. The patient recuperated successfully, and the liver's function and AFP levels gradually tended to normalize 2 weeks after the operation. Ultrasonic examination revealed that the blood flow velocity of the hepatic vein, portal vein, and hepatic artery was good. The patient recovered and was discharged 3 weeks after the operation. Ex vivo liver resection and autotransplantation have great application value for complicated HB in children that is not suitable for conventional hepatic lobectomy.

The extracorporeal circulation with transdiaphragmatic approach in living‐donor liver transplantation for HB with atrial extension of tumor thrombus: A case report

“…Vascular reconstruction with extracorporeal circulation is a challenging surgical technique in hepatic resection or LT for HB with tumor thrombi extending into the IVC and RA. To the best of our knowledge, 16 cases of extracorporeal circulation for cases of HB with IVC thrombi or RA (including the present case) have been reported, as shown in Table 1 6,9,12,22‐26 . Hepatic resection was performed under cardiopulmonary bypass with hypothermic perfusion.…”

“…To the best of our knowledge, 16 cases of extracorporeal circulation for cases of HB with IVC thrombi or RA (including the present case) have been reported, as shown in Table 1. 6,9,12,[22][23][24][25][26] Hepatic resection was performed under cardiopulmonary bypass with hypothermic perfusion. Previously, some cases were associated with postoperative mortality or morbidity, such as postoperative death due to pulmonary embolism, 23 and ischemic cholangiopathy requiring subsequent LT. 25 However, recent studies reported that the postoperative course was uneventful and that patients were discharged within a month after the operation.…”

“…Homograft replacement of the retrohepatic IVC at LT and auto-transplantation with ex vivo liver resection under cardiopulmonary bypass has been reported as a new approach to overcome these problems in patients with unresectable liver malignancy. 6,7 To the best of our knowledge, there are only a few reports of HB with a tumor thrombus extending into the RA in which the tumor was successfully resected using extracorporeal circulation. [8][9][10] The establishment of the surgical technique for LDLT in cases involving HB extending into the RA will contribute to improving the prognosis of these patients.…”

“…These findings make it difficult to achieve complete resection of the tumor. Homograft replacement of the retrohepatic IVC at LT and auto‐transplantation with ex vivo liver resection under cardiopulmonary bypass has been reported as a new approach to overcome these problems in patients with unresectable liver malignancy 6,7 …”

Advances in the conventional clinical treatment for hepatoblastoma and therapeutic innovation

“…6 33 For the unresectable HB, liver transplantation may be effective, with a long-term survival rate of 80% after combination treatment. [34][35][36] Shi et al 37 successfully implemented ex vivo liver resection and autotransplantation for children with HB. The procedure includes removal of the malignancy in vitro or semi-in vivo, transplanting the remaining liver and anastomosing the superior and inferior vena cava, bile duct and other duct systems to restore the liver blood supply.…”