In-situ, ante-situm, and ex-situ surgical approaches for otherwise irresectable hepatic tumors

Oldhafer, Karl J.; Bornscheuer, A.; Pichlmayr, R.

doi:10.1007/bf02620208

Cited by 11 publications

(13 citation statements)

References 9 publications

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“…On the other hand, the reported postoperative mortality up to 28%, specifically in ex situ resection, and in some cases the need for salvage liver transplantation due to hepatic failure calls for care in applying this technique [44,45,46]. After adequate consideration of potential advantages and disadvantages of all available alternatives, however, these techniques may turn out to be the most appropriate approach in certain patients [22]. …”

Section: Discussionmentioning

confidence: 99%

“…If no other treatment option is available, resection under hypothermic perfusion may be considered, but the increased risk has to be acknowledged. In cases with cholestatic liver malfunction, preoperative biliary drainage of the liver should be considered to improve liver function prior to resection [22]. Our experience shows that the target bilirubin level to perform the resection safely should be below 5–10 mg/dl.…”

Section: Indications For Ante Situm Liver Resectionmentioning

confidence: 99%

“…Category 3 includes the patients in whom conventional resection is not possible, liver transplantation is contraindicated, and there are no other options of surgical treatment except advanced resection techniques. With the current organ shortage, hypothermic liver resection techniques seem reasonable in patients of categories 2 or 3, and provide the only chance of cure, or at least of substantial gain of life time [22]. However, the potential advantages and disadvantages of these techniques have to be weighed against each other and against those of conventional resection techniques in each individual patient.…”

Section: Indications For Ante Situm Liver Resectionmentioning

confidence: 99%

“…With this approach, the ante situm technique would be the most appropriate technique in the majority of patients in whom the portal pedicle can usually be maintained. The final decision between in situ or ante situm resection can only be made intraoperatively [22]. …”

Section: Indications For Ante Situm Liver Resectionmentioning

confidence: 99%

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Hypothermic ante situm Resection in Tumors of the Hepatocaval Confluence

et al. 2011

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Primary liver malignancies together with metastatic liver tumors are among the most common tumors in human. The best available treatment option for these diseases is surgical resection. One major parameter which had been considered as contraindication for liver resection owing to technical difficulties in achieving tumor-free margins was the involvement of the hepatocaval confluence. To overcome this problem, several techniques including hypothermic in situ, ante situm and ex situ liver resection have been introduced. The common basis for these liver resections is the total vascular exclusion of the liver, and perfusion of the organ by preservation solution under hypothermic conditions. The major indications for the ante situm liver resection are tumors in the liver that are either unresectable or inadequately resectable by conventional surgery because they involve the venous confluence and/or the retrohepatic vena cava, or are in close proximity to them. This technique is a realistic option to achieve surgical cure or substantial gain of life time with quality of life in otherwise unresectable tumors of the liver. Due to fewer anastomoses, the ante situm approach is easier and safer than the ex situ approach, with an acceptable morbidity and mortality rate. Patient selection is of utmost importance to achieve a good outcome. To minimize the postoperative morbidities and mortality, this procedure requires a multidisciplinary approach and should be performed in experienced centers with a high case volume of hepatobiliary surgeries.

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Section: Discussionmentioning

confidence: 99%

Section: Indications For Ante Situm Liver Resectionmentioning

confidence: 99%

Section: Indications For Ante Situm Liver Resectionmentioning

confidence: 99%

Section: Indications For Ante Situm Liver Resectionmentioning

confidence: 99%

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Hypothermic ante situm Resection in Tumors of the Hepatocaval Confluence

et al. 2011

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“…Due to the longer operation time in this procedure, it is essential to maintain the stability of blood dynamics and avoid venous congestion; an effective veno-venous bypass should thus be used. The same technique is applied as in liver transplantation, with bypass from the portal and left femoral veins to the left axillary or jugular vein using heparin-coated shunts and a roller pump [18]. Yang et al [2] reported an alternate technique to avoid adjuvant incisions and other shortcomings or shortages of conventional veno-venous bypass, in which the IVC was replaced with an artificial blood vessel, and a temporary veno-venous bypass was then performed after liver removal by anatomizing the portal vein and the supra- and infrahepatic venae cavae, respectively.…”

Section: Technical Aspects Of Ex Situ Resectionmentioning

confidence: 99%

Ex situ Liver Resection for Unresectable Tumors

Lei

Liu²,

Liu³

et al. 2012

Dig Surg

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Primary and secondary liver tumors are among the most common tumors in humans. Two surgical approaches may be used to address these tumors: liver transplantation and liver resection. However, some tumors cannot be treated by conventional techniques or liver transplantation due to poor intraoperative exposure, limitations of indication standards, and/or other complex factors. To overcome these problems, ex situ liver resection has been introduced and used successfully in many cases. This technique is based primarily on liver transplantation and perfusion with preservation solution under hypothermic conditions. The major indications for ex situ liver resection are liver tumors that are unresectable or in which resection using conventional surgical techniques is very dangerous due to the close proximity to or involvement of the venous confluence and/or the main hepatic veins. However, high mortality and morbidity rates limit the use of this technique despite the efforts of many surgeons to improve their skills. Patient selection is of utmost importance to achieve a good outcome. Emphasis on basic research (e.g. on reperfusion injury) and the development of key techniques should improve the safety of the procedure and reduce mortality in the future.

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