Abstract
Purpose
Ex vivo hepatectomy with autotransplantation (EHAT) provides opportunity for R0 resection. As EHAT outcomes after future liver remnant (FLR) augmentation techniques are not well documented, we examine results of EHAT after augmentation for malignant tumors.
Methods
Retrospective analysis of six cases of EHAT was performed. Of these, four occurred after preoperative FLR augmentation between 2018 and 2022.
Results
Six patients were offered EHAT of 26 potential candidates. Indications for resection were involvement of hepatic vein outflow and inferior vena cava (IVC) with metastatic colorectal carcinoma (n = 3), cholangiocarcinoma (n = 2), or leiomyosarcoma (n = 1). Five patients were treated with neoadjuvant chemotherapy and four had preoperative liver augmentation. One hundred percent of cases achieved R0 resection. Of the augmented cases, three patients are alive after median follow-up of 28 months. Postoperative mortality due to liver failure was 25% (n = 1).
Conclusions
For select patients with locally advanced tumors involving all hepatic veins and the IVC for whom conventional resection is not an option, EHAT provides opportunity for R0 resection. In addition, in patients with inadequate FLR volume, further operative candidacy with acceptable results can be achieved by combined liver augmentation techniques. To better characterize outcomes in this small subset, a registry is needed.
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Maria Baimas-George MD MPH — study conception and design, acquisition of data, analysis and interpretation of data, drafting of manuscript, critical revision of manuscript; Matthew S. Strand MD — analysis and interpretation of data, drafting of manuscript; Joshua M. Davis MD — analysis and interpretation of data, drafting of manuscript; Lon B. Eskind MD — acquisition of data, analysis and interpretation of data, critical revision of manuscript; Mark Lessne MD — acquisition of data, analysis and interpretation of data, critical revision of manuscript; David M. Levi MD — acquisition of data, analysis and interpretation of data, critical revision of manuscript; Dionisios Vrochides MD, PhD — study conception and design, acquisition of data, analysis and interpretation of data, drafting of manuscript, critical revision of manuscript
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Baimas-George, M., Strand, M.S., Davis, J.M. et al. Future liver remnant augmentation preceding ex vivo hepatectomy with IVC replacement: a strategy to achieve R0 margins. Langenbecks Arch Surg 408, 156 (2023). https://doi.org/10.1007/s00423-023-02902-8
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DOI: https://doi.org/10.1007/s00423-023-02902-8