title: Ex-situ liver surgery without veno-venous bypass.
abstract: OBJECTIVE
  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).
  
  
  CONCLUSIONS
  Ex-situ liver resection and liver autotransplantation has shown a potential for treatment of complicated hepatic neoplasms that are unresectable by traditional procedures.
authors: Department of Hepatobiliary Surgery, 302 Hospital of Chinese People's Liberation Army, Beijing 100039, China.
authors: Ke-Ming
authors: KM
authors: Zhang
authors: Xiong-Wei
authors: XW
authors: Hu
authors: Jia-Hong
authors: JH
authors: Dong
authors: Zhi-Xian
authors: ZX
authors: Hong
authors: Zhao-Hai
authors: ZH
authors: Wang
authors: Gao-Hua
authors: GH
authors: Li
authors: Rui-Zhao
authors: RZ
authors: Qi
authors: Wei-Dong
authors: WD
authors: Duan
authors: Shao-Geng
authors: SG
authors: Zhang
mesh_terms: D018281:Cholangiocarcinoma / Q000601:surgery; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006503:Hepatic Veins / Q000601:surgery*; D006801:Humans; D007036:Hypothermia, Induced; D008099:Liver / Q000601:surgery*; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010477:Perfusion; D011183:Postoperative Complications; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014682:Vena Cava, Inferior / Q000601:surgery
keywords: Ex-situ resection; Liver autotransplantation; Liver tumor; Total vascular exclusion