In situ reconstruction of vascular inflow/outflow to left lateral liver section, ex-vivo liver resection and autologous liver transplantation of remaining liver remnant for hepatic alveolar echinococcosis

Zhang, Yu; Lai, Eric C. H.; Yang, Chong; Yang, Hongji; Li, Jun; Zhou, Guo; Xian, Di; Deng, Shaoping; Lau, Wan Yee

doi:10.1016/j.ijscr.2020.03.023

Cited by 14 publications

(10 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The overall incidence of major morbidity was 38.24% (39/102), with a median CCI of 20.92 (0.00-26.22), and the 90-day mortality rate was 10.78% (11/102). The median postoperative stay and ICU stay were 20 (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31) and 4 (3-5) days, respectively.…”

Section: Perioperative Resultsmentioning

confidence: 99%

“…Developed by Rudolf Pichlmayr and his team, ELRA was primarily utilized in the treatment of "unresectable" hepatobiliary malignant tumors and has been reported to be a promising alternative to liver allotransplantation in treating end-stage HAE (8,24,25), a chronic tumor-like infectious disease that is highly sensitive to immunosuppressive therapy (26,27). Regarding the treatment of end-stage HAE, the difficulty of ELRA is associated mainly with the following: (1) the enlarged scale of combined resection caused by extensive lesion invasion;…”

Section: Discussionmentioning

confidence: 99%

“…Developed by Rudolf Pichlmayr and his team, ELRA was primarily utilized in the treatment of “unresectable” hepatobiliary malignant tumors and has been reported to be a promising alternative to liver allotransplantation in treating end-stage HAE ( 8 , 24 , 25 ), a chronic tumor-like infectious disease that is highly sensitive to immunosuppressive therapy ( 26 , 27 ). Regarding the treatment of end-stage HAE, the difficulty of ELRA is associated mainly with the following: ( 1 ) the enlarged scale of combined resection caused by extensive lesion invasion; ( 2 ) the identification and preservation of abnormal vessels under a bloodless circumstance during bench resection and simultaneous radical resection of the liver parenchyma; ( 3 ) highly individualized plasty and reconstruction of impaired vessels; and ( 4 ) maintenance of hemodynamics and homeostasis during the operation.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Learning Curve of Ex Vivo Liver Resection and Autotransplantation in Treating End-Stage Hepatic Alveolar Echinococcosis: A RA-CUSUM Analysis

et al. 2021

View full text Add to dashboard Cite

Background: This retrospective study aimed to evaluate the safety and learning curve of ex vivo liver resection and autotransplantation (ELRA).Methods: A total of 102 consecutive end-stage HAE patients who underwent ELRA between 2014 and 2020 in West China Hospital were enrolled. The primary endpoint was major postoperative complications (comprehensive complication index, CCI > 26). The ELRA learning curve was evaluated using risk-adjusted cumulative sum (RA-CUSUM) methods. The learning phases were determined based on RA-CUSUM analysis and tested for their association with intra- and post-operative endpoints.Results: The median surgery time was 738 (659–818) min, with a median blood loss of 2,250 (1,600–3,000) ml. The overall incidence of major morbidity was 38.24% (39/102). Risk-adjusted cumulative sum analysis demonstrated a learning curve of 53 ELRAs for major postoperative complications. The learning phase showed a significant association with the hemodynamic unstable time (HR −30.29, 95% CI −43.32, −17.25, P < 0.0001), reimplantation time (HR −13.92, 95% CI −23.17, −4.67, P = 0.004), total postoperative stay (HR −6.87, 95% CI −11.33, −2.41, P = 0.0033), and postoperative major morbidity (HR 0.25, 95% CI 0.09, 0.68, p = 0.007) when adjusted for age, disease course, liver function, and remote metastasis.Discussion:Ex vivo liver resection and autotransplantation is feasible and safe with a learning curve of 53 cases for major postoperative complications.

show abstract

Section: Perioperative Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Learning Curve of Ex Vivo Liver Resection and Autotransplantation in Treating End-Stage Hepatic Alveolar Echinococcosis: A RA-CUSUM Analysis

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Since the surgical technique of ELRA was used to treat end-stage HAE in 2011, 48 an increasing number of ELRA procedures for HAE have been reported by medical centers. 7 , 11 , 49–52 For ELRA, the limitations of liver allotransplantation become strengths, including no need for donors and immunosuppressive drugs as well as lower therapy costs. As ELRA involves a series of complex surgical procedures, postoperative complications become more of a concern.…”

Section: Discussionmentioning

confidence: 99%

A Sarcopenia-Based Prediction Model for Postoperative Complications of ex vivo Liver Resection and Autotransplantation to Treat End-Stage Hepatic Alveolar Echinococcosis

Sun¹,

Wang²,

Qiu³

et al. 2021

IDR

View full text Add to dashboard Cite

“…Shorten the anhepatic term is significant for reducing complications such as pulmonary thromboembolism and post-reperfusion syndrome (55). Based on the experience in LDLT (56,57), the author's group modified the traditional ERAT procedure as resecting the lesions in vivo firstly, rather than remove the entire liver for lesion resection in vitro directly (31). Once excision plane reached the invaded HVs or RHIVC which could not be dissected from the HAE lesion in vivo, it's time for removing the liver into an ice bath for further bench resection.…”

Section: Surgical Proceduresmentioning

confidence: 99%

Current status of ex-vivo liver resection and autologous liver transplantation for end-stage hepatic alveolar echinococcosis

Yang

Deng

et al. 2020

Ann Palliat Med

Self Cite

View full text Add to dashboard Cite

Hepatic alveolar echinococcosis (HAE) is a cosmopolitan zoonosis distribute widely in the northern hemisphere with high estimated 10-year mortality. Radical resection combined with oral albendazole administration are the major methods for HAE treatment, whereas most patients delayed diagnosis and treatment because which was considered as benign disease. For the cases with end-stage HAE could not be treated through conventional hepatectomy, allograft liver transplantation (LT) was regarded as a life-saving technique previously. However, graft shortage, high recurrence rate and long-term immunosuppressive therapy limited its utilization. Since the ex-vivo liver resection and autotransplantation (ERAT) procedure was first used in treating for end-stage HAE in 2011, there are more than 120 HAE cases patients were reported treating in this method up to now. Comparing with LT, ERAT needs neither an organ donor nor long term immunosuppressive therapy, and provide preferable overall survival rates. Based on the conventional ERAT procedure, some modification such as auxiliary partial autologous LT were introduced in the high selected end-stage HAE patients presently. However, the standard procedures for ERAT including surgical details and perioperative management have not been established because of limited reported cases. Also, the present ERAT experience for end-stage HAE treatment are all summarizes by the Chinese surgeon groups. For summarizing the knowledge and experience details, we reviewed present opinions about ERAT for end-stage HAE patients, and presented the future perspectives about this topic in this manuscript. We aimed at discussing the feasibility, indications, preparation, technical details, and postoperative outcomes of ERAT for HAE patients.

show abstract

In situ reconstruction of vascular inflow/outflow to left lateral liver section, ex-vivo liver resection and autologous liver transplantation of remaining liver remnant for hepatic alveolar echinococcosis

Cited by 14 publications

References 18 publications

Learning Curve of Ex Vivo Liver Resection and Autotransplantation in Treating End-Stage Hepatic Alveolar Echinococcosis: A RA-CUSUM Analysis

Learning Curve of Ex Vivo Liver Resection and Autotransplantation in Treating End-Stage Hepatic Alveolar Echinococcosis: A RA-CUSUM Analysis

A Sarcopenia-Based Prediction Model for Postoperative Complications of ex vivo Liver Resection and Autotransplantation to Treat End-Stage Hepatic Alveolar Echinococcosis

Current status of ex-vivo liver resection and autologous liver transplantation for end-stage hepatic alveolar echinococcosis

Contact Info

Product

Resources

About