Current indications of ex-situ liver resection: A systematic review

Background: Ex situ liver resection and autotransplantation, a surgical technique introduced for man-aging advanced and unresectable malignant tumors, never became a popular surgical procedure, due mainly to the high incidence of adverse events and postoperative recurrences. This study aims to assess the clinical outcomes of ex situ liver resection and autotransplantation in the currently available literature. Methods: The PubMed electronic database was used to retrieve studies that meet the inclusion criteria for the topic. Results: Twenty-nine studies were included. The mean (range) 90-day mortality rate was 11.6% (0%-50%) and the mean overall survival was 55.8% (12.5%-100.0%). R0 resection was achieved in 100% of cases. In the overall study sample, the maximum tumor size was found to be positively correlated with the 90-day mortality rate (P = .047) and negatively correlated with the overall survival (P = .048). The mean number of total resected segments appeared to be positively correlated with the length of hospital stay (P = .039). In the malignant tumor sample, there was a significant relationship between the maximum tumor size and postoperative liver failure, 90-day mortality rate (P = .027 and P = .034, respectively), and between the mean length of anhepatic phase and mean length of hospital stay (P = .0092). Conclusion: The ex situ liver resection and autotransplantation appears to be a valuable option in selected patients with conventionally unresectable hepatic tumors and normal liver function. However, it was not possible to provide clear and unequivocal recommendations about this procedure. To rectify this, an international database to help surgeons in their decision-making process ought to be established. (c) 2022 Elsevier Inc. All rights reserved.

Automated summary

Ex situ liver resection and autotransplantation is a valuable option for patients with conventionally unresectable hepatic tumors and normal liver function. However, there are risks of adverse events and postoperative recurrences. Tumor size and resection range are correlated with surgical outcomes.