Skip to main content

Advertisement

Log in

Ex Situ Resection Techniques and Liver Autotransplantation: Last Resource for Otherwise Unresectable Malignancy

  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Ex vivo liver resection and hepatic autotransplantation allow treatment of otherwise unresectable hepatobiliary malignancy and expand the role of liver surgery. Few series are reported in the English literature, and they are mainly case reports focused on the technical aspects of the procedure more than on the long-term results. Postoperative mortality rate is still high, as well as early tumor recurrence; recently, improvement in outcomes in selected cases is being reported. The aim of this study is to describe our experience with two cases where we applied the combination of ex situ resection with hepatic autotransplantation for intended cure of two otherwise untreatable malignancies. These two cases are the paradigm of the possibility of performing extreme salvage procedures after the failure of more conventional treatments, allowing improvement in survival and quality of life in a controversial clinical scenario. This should be performed only AT referral centers for liver resection surgery and liver transplantation in light of the technical refinements reached in the era of living-related liver transplantation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Kadry Z, Furukawa H, Todo S, Clavien PA: Assessment of liver function and mass in cirrhotic and non cirrhotic livers. In Malignant Liver Tumors: Current and Emerging Therapies, 2nd ed. Clavien PA FY, Lyerly HK, Morse MA, Venook AP (eds). Sudbury, UK, Jones and Bartlett, 2003, pp 73–88

    Google Scholar 

  2. Pringle JH: Notes on the arrest of hepatic hemorrhage due to trauma. Ann Surg 48:541–549, 1908

    Google Scholar 

  3. Heaney JP, Jacobson A: Simplified control of upper abdominal hemorrhage from the vena cava. Surgery 78(2):138–141, 1975

    PubMed  Google Scholar 

  4. Makuuchi M, Thai BL, Takayasu K, Takayama T, Kosuge T, Gunven P, Yamazaki S, Hasegawa H, Ozaki H: Preoperative portal embolization to increase safety of major hepatectomy for hilar bile duct carcinoma: a preliminary report. Surgery 107(5):521–527, 1990

    PubMed  Google Scholar 

  5. Marcos A: Right lobe living donor liver transplantation: a review. Liver Transplant 6(1):3–20, 2000

    Google Scholar 

  6. Starzl TE, Marchioro TL, Kaula KN, Von Herman G, Brittain RS, Waddel WR: Homotransplantation of the human liver. Ann Surg 177:659–676, 1963

    Google Scholar 

  7. Starzl TE, Groth CT, Brettschneider L, et al.: Othotopic homotransplantation of the human liver. Ann Surg 168:392–415, 1968

    PubMed  Google Scholar 

  8. Belghiti J, Makuuchi M: Technical progress in liver transplantation. HPB Off J Int Hepato Pancreato Bil Assoc 6(2):67–68, 2004

    Article  Google Scholar 

  9. Heffron TG, Gruttadauria S, Campi O, et al.: Surgical innovations in pediatric liver transplantation: Reduced-size, split, and living-related transplantation. Prob Gen Surg 15:104–111, 1998

    Google Scholar 

  10. Gruttadauria S, Foglieni CS, Doria C, Luca A, Lauro A, Marino IR: The hepatic artery in liver transplantation and surgery: vascular anomalies in 701 cases. Clin Transplant 15(5):359–363, 2001

    Article  PubMed  Google Scholar 

  11. Fong Y, Sun RL, Jarnagin W, Blumgart LH: An analysis of 412 cases of hepatocellular carcinoma at a Western center. Ann Surg 229(6):790–799, discussion 799–800, 1999

    Google Scholar 

  12. Belghiti J, Hiramatsu K, Benoist S, Massault P, Sauvanet A, Farges O: Seven hundred forty-seven hepatectomies in the 1990s: an update to evaluate the actual risk of liver resection. J Am Coll Surg 191(1):38–46, 2000

    Article  PubMed  Google Scholar 

  13. Rougier P, Milan C, Lazorthes F, Fourtanier G, Partensky C, Baumel H, Faivre J: Prospective study of prognostic factors in patients with unresected hepatic metastases from colorectal cancer. Fondation Francaise de Cancerologie Digestive. Br J Surg 82(10):1397–1400, 1995

    PubMed  Google Scholar 

  14. Isenberg J, Fischbach R, Kruger I, Keller HW: Treatment of liver metastases from colorectal cancer. Anticancer Res 16(3A):1291–1295, 1996

    PubMed  Google Scholar 

  15. Shaw BW Jr, Martin DJ, Marquez JM, Kang YG, Bugbee AC Jr, Iwatsuki S, Griffith BP, Hardesty RL, Bahnson HT, Starzl TE: Venous bypass in clinical liver transplantation. Ann Surg 200(4):524–534, 1984

    PubMed  Google Scholar 

  16. Raab R, Schlitt HJ, Oldhafer KJ, Bornscheuer A, Lang H, Pichlmayr R: Ex-vivo resection techniques in tissue-preserving surgery for liver malignancies. Langenbecks Arch Surg 385(3):179–184, 2000

    Article  PubMed  Google Scholar 

  17. Oldhafer KJ, Lang H, Schlitt HJ, Hauss J, Raab R, Klempnauer J, Pichlmayr R: Long-term experience after ex situ liver surgery. Surgery 127(5):520–527, 2000

    Article  PubMed  Google Scholar 

  18. Hemming AW, Reed AI, Langham MR Jr, Fujita S, Howard RJ: Combined resection of the liver and inferior vena cava for hepatic malignancy. Ann Surg 239(5):712–719, discussion 719–721, 2004

    Google Scholar 

  19. Starzl TE, Putnam CW (eds): Experience in Hepatic Transplantation. Philadelphia, PA, W. B. Saunders, 1969

  20. Greenlee RT, Murray T, Bolden S, Wingo PA: Cancer statistics, 2000. CA Cancer J Clin 50(1):7–33, 2000

    PubMed  Google Scholar 

  21. Marsh JW, Geller DA, Finkelstein SD, Donaldson JB, Dvorchik I: Role of liver transplantation for hepatobiliary malignant disorders. Lancet Oncol 5(8):480–488, 2004

    Article  PubMed  Google Scholar 

  22. Parker SL, Tong T, Bolden S, Wingo PA: Cancer statistics, 1996. CA Cancer J Clin 46(1):5–27, 1996

    PubMed  Google Scholar 

  23. Chui AK, Rao AR, Wong J, Mann D, Leung KF, Lau WY: Ex situ ex vivo liver resection, partial liver autotransplantation for advanced hilar cholangiocarcinoma: a case report. Transplant Proc 35(1):402–403, 2003

    Article  PubMed  Google Scholar 

  24. Gruttadauria S, Marino G, Catalano F, Sgroi AV, Di Mauro GL, Basile F: Porcine orthotopic liver autotransplantation: facilitated technique. J Invest Surg 14(2):79–82, 2001

    Article  PubMed  Google Scholar 

  25. Chui AK, Island ER, Rao AR, Lau WY: The longest survivor and first potential cure of an advanced cholangiocarcinoma by ex vivo resection and autotransplantation: a case report and review of the literature. Am Surg 69(5):441–444, 2003

    PubMed  Google Scholar 

  26. Yuzer Y, Zeytunlu M, Makay O, Sozbilen M, Yuce G: Leiomyosarcoma of the inferior vena cava: report of a case. Surg Today 34(4):370–373, 2004

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gruttadauria, S., Marsh, J.W., Bartlett, D.L. et al. Ex Situ Resection Techniques and Liver Autotransplantation: Last Resource for Otherwise Unresectable Malignancy. Dig Dis Sci 50, 1829–1835 (2005). https://doi.org/10.1007/s10620-005-2946-5

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-005-2946-5

Key Words

Navigation