Hypothermic perfusion hepatectomy for unresectable liver cancer: A single‐center experience

Abstract

Background:The resection of liver tumors that involve the hepatic veins adjacent to the vena cava or hepatic hilum is technically challenging. We present our surgical techniques and the long-term outcome of five patients with conventionally unresectable tumors. Methods: Five patients with conventionally unresectable tumors were successfully treated by "ex-situ liver resection" and "in-situ and ante-situm hypothermic liver perfusion" under total vascular exclusion and venovenous bypass. Results: These approaches allowed complete tumor removal with vascular reconstruction under a bloodless surgical field, while minimizing hepatic ischemic injury and preserving liver function. No perioperative mortalities occurred, and postoperative complications were minimal. The postoperative survival periods were limited due to the advanced malignancies in our patients, but the survival benefit was encouraging. The median postoperative survival time was 29.1 months, with the longest survival period being nearly 10 years. These approaches improved the quality of life and provided an opportunity for additional treatment. Conclusions: Hypothermic perfusion hepatectomy is a realistic option for achieving surgical cure or significantly improved survival and quality of life in patients with tumors deemed unresectable using conventional normothermic hepatectomy. These approaches can overcome the limitations of the liver's restricted normothermic ischemia tolerance or inaccessible tumor locations. K E Y W O R D Sante-situm liver resection, ex-situ liver resection, hepatectomy, hypothermic perfusion, total vascular exclusion

Predictors of Liver Failure in Non‐Cirrhotic Patients Undergoing Hepatectomy

“…Previous studies have suggested that greater than 5% hypertrophy in the intended remnant improves outcomes after PVE [19]. Other approaches to mitigate the risk of PHLF include “associating liver partition and portal vein ligation for staged hepatectomy” (ALPPS) [21, 22], radiation lobectomy [23, 24], liver venous deprivation [18, 25], and hypothermic perfusion [26].…”

Transferability of Liver Transplantation Experience to Complex Liver Resection for Locally Advanced Hepatobiliary Malignancy-Lessons Learnt From 3 Decades of Single Center Experience

“…Most of the cases operated in this study was mainly indicated for locally advanced hepatobiliary malignancies with a substantial proportion of patients with single bulky tumor that had macrovascular invasion, or adjacent organ invasion. Such tumor high tendency to invade major intrahepatic vasculature often demanded portal vein or hepatic vein reconstruction to achieve a R0 resection, 23,24 or in the case of hilar cholangiocarcinoma when portal vein resection was often needed for tumor clearance 25 due to its proximity to portal vein at the biliary confluence. Rare tumors, for example, leiomyosarcoma of the retrohepatic vena cava with juxtaposition to the liver (Fig.…”