World J Gastroenterol. 2012 December 28; 18(48): 7290-7295.
Published online 2012 December 28. doi: 10.3748/wjg.v18.i48.7290.
Ex-situ liver surgery without veno-venous bypass
Ke-Ming Zhang, Xiong-Wei Hu, Jia-Hong Dong, Zhi-Xian Hong, Zhao-Hai Wang, Gao-Hua Li, Rui-Zhao Qi, Wei-Dong Duan and Shao-Geng Zhang.
Ke-Ming Zhang, Xiong-Wei Hu, Zhi-Xian Hong, Zhao-Hai Wang, Gao-Hua Li, Rui-Zhao Qi, Wei-Dong Duan, Shao-Geng Zhang, Department of Hepatobiliary Surgery, 302 Hospital of Chinese People’s Liberation Army, Beijing 100039, China
Jia-Hong Dong, Wei-Dong Duan, Department of Hepatobiliary Surgery, General Hospital of Chinese People’s Liberation Army, Beijing 100853, China
Author contributions: Zhang KM and Hu XW contributed equally to this work, performed the majority of this study and wrote the manuscript; Dong JH coordinated the study and revised the manuscript; Hong ZX, Wang ZH, Li GH, Qi RZ and Duan WD participated in the clinical work; and Zhang SG was also involved in revising the manuscript.
Correspondence to: Dr. Jia-Hong Dong, MD, Department of Hepatobiliary Surgery, General Hospital of Chinese People’s Liberation Army, Beijing 100853, China. dongjiahong301@126.com
Telephone: +86-10-66936037 Fax: +86-10-63946028
Received March 3, 2012; Revised July 27, 2012; Accepted July 29, 2012;
Abstract
AIM: To evaluate the results of hepatic resection with ex-situ hypothermic perfusion and without veno-venous bypass.
METHODS: In 3 patients with liver tumor, the degree of the inferior vena cava and/or main hepatic vein involvement was verified when the liver was dissociated in the operation. It was impossible to resect the tumors by the routine hepatectomy, so the patients underwent ex-situ liver surgery, vein cava replacement and hepatic autotransplantation without veno-venous bypass. All surgical procedures were carried out or supervised by a senior surgeon. A retrospective analysis was performed for the prospectively collected data from patients with liver tumor undergoing ex-situ liver surgery, vein cava replacement and hepatic autotransplantation without veno-venous bypass. We also compared our data with the 9 cases of Pichlmayr’s group.
RESULTS: Three patients with liver tumor were analysed. The first case was a 60-year-old female with a huge haemangioma located in S1, S4, S5, S6, S7 and S8 of liver; the second was a 64-year-old man with cholangiocarcinoma in S1, S2, S3 and S4 and the third one was a 55-year-old man with a huge cholangiocarcinoma in S1, S5, S7 and S8. The operation time for the three patients were 6.6, 6.4 and 7.3 h, respectively. The anhepatic phases were 3.8, 2.8 and 4.0 h. The volume of blood loss during operation were 1200, 3100, 2000 mL in the three patients, respectively. The survival periods without recurrence were 22 and 17 mo in the first two cases. As for the third case complicated with postoperative hepatic vein outflow obstruction, emergency hepatic vein outflow extending operation and assistant living donor liver transplantation were performed the next day, and finally died of liver and renal failure on the third day. Operation time (6.7 ± 0.47 h vs 13.7 ± 2.6 h) and anhepatic phase (3.5 ± 0.64 h vs 5.7 ± 1.7 h) were compared between Pichlmayr’s group and our series (P = 0.78).
CONCLUSION: Ex-situ liver resection and liver autotransplantation has shown a potential for treatment of complicated hepatic neoplasms that are unresectable by traditional procedures.
Keywords: Liver autotransplantation, Ex-situ resection, Total vascular exclusion, Liver tumor