Ex vivo liver resection and auto-transplantation as an alternative for the treatment of liver malignancies: Progress and challenges

Hepatectomy is still the major curative treatment for patients with liver malignancies.However,it is still a big challenge to remove the tumors in the central posterior area,especially if their location involves the retrohepatic inferior vena cava and hepatic veins.Ex vivo liver resection and auto-transplantation(ELRA),a hybrid technique of the traditional liver resection and transplantation,has brought new hope to these patients and therefore becomes a valid alternative to liver transplantation.Due to its technical difficulty,ELRA is still concentrated in a few hepatobiliary centers that have experienced surgeons in both liver resection and liver transplantation.The efficacy and safety of this technique has already been demonstrated in the treatment of benign liver diseases,especially in the advanced alveolar echinococcosis.Recently,the application of ELRA for liver malignances has gained more attention.However,standardization of clinical practice norms and international consensus are still lacking.The prognostic impact in these oncologic patients also needs further evaluation.In this review,we summarized the principles and recent progresses on ELRA.

A new veno-venous bypass type for ex-vivo liver resection in dogs

Ex-vivo liver resection is a procedure in which the liver is completely removed, perfused and after bench surgery, the liver is autotransplanted to the original site. Ex vivo liver resection is an important treatment for unresectable liver tumors. This surgical procedure requires long operation time, during which blood flow must be carefully maintained to avoid venous congestion. An effective veno-venous bypass (VVB) may meet this requirement. The present study was to test our new designed VVB device which comprised one heparinized polyvinylchloride tube and three magnetic rings The efficacy of this device was tested in five dogs. A VVB was established in 6-10 minutes. There was no leakage during the procedure. Hemodynamics was stable at anhepatic phase, which indicated that the bypass was successful. This newly-developed VVB device maintained circulation stability during ex-vivo liver resection in our dog model and thus, this VVB device significantly shortened the operation time.

Insight into the history and trends of liver transplantation for echinococcosis:A bibliometric analysis

BACKGROUND Liver transplantation(LT)has demonstrated favorable efficacy in managing endstage alveolar echinococcosis.Nevertheless,the current research focal points and advancement trends remain ambiguous.AIM To map the research landscape to underscore critical areas of focus,influential studies,and future directions of LT for echinococcosis treatment.METHODS Publications on LT for echinococcosis treatment published between 1900 and 2023 were searched in the Web of Science database and analyzed using bibliometrics.RESULTS A total of 14 countries/regions,75 institutions,and 499 authors have published research articles,with China,Turkey,and France being the three most productive countries.The four institutions with the most contributions were Sichuan University,Xinjiang Medical University,the University de Franche Comte,and Inonu University.The three authors who contributed the most were Wen Hao,Wang Wentao,and Bresson Hadni Solange.The four most common keywords were alveolar echinococcosis,LT,ex-vivo liver resection and autotransplantation,and echinococcosis multilocularies.CONCLUSION Our study found that the treatment of complications after LT for echinococcosis treatment and the preoperative surgical plan based on the anatomical relationship between the lesion and the blood vessel are early research hotspots.Recent research focuses on the treatment of complications after ex-vivo liver resection and autotransplantation,especially vascular complications.

Auto-intestine transplantation for pancreatic tumors with mesenteric root involvement:a systematic review and survival-based analysis

To analyze a long-term survival outcome of an auto-intestine transplantation(aINTx)for the patients with locally advanced pancreatic tumor and identify the potential prognostic factors,databases were carefully searched for the studies reporting the patients with a locally advanced pancreatic tumor which typically underwent aINTx.We performed a database search using PubMed,the Cochrane Library,EMBASE,and MEDLINE to identify multiple case series of the patients who had pancreatic tumors with mesenteric root involvement and underwent aINTx,to evaluate the treatment outcomes,and calculated the patient survival using the Kaplan–Meier method and Cox proportional hazard regression analysis to properly identify an independent predictor of the survival.A total of 9 retrospective studies with a total of 29 patients were included in our study.The calculated 1-,2-,and 3-year survival rates for the patients with pancreatic cancer and benign or low grade pancreatic tumors were 49.64%,22.06%,and 0%versus 100%,100%,and 80%,respectively.The corresponding median survival time was 13.4months and 84months,respectively.Moreover,when stratifying the pancreatic cancer patients undergoing aINTx on the basis of neoadjuvant chemotherapy(aINTx+neoadjuvant vs aINTx-neoadjuvant)there was a significant difference in the survival(P=0.01).The 1-and 2-year survival rates were 75%and 75%versus 34.1%and 0%,respectively.Corresponding median survival times were 24months and 10months,respectively.Our analysis shows the long-term survival benefit with acceptable morbidity and mortality of pancreatoduodenectomy and aINTx for the pancreatic tumors with the mesenteric root involvement that are otherwise unresectable by the conventional surgical techniques.However,from an oncological point of view,a larger study with the control group is required to determine its safety compared to less aggressive surgical treatment.