<i>Ex vivo</i> liver resection followed by autotransplantation in the treatment of advanced hepatic alveolar echinococcosis: a report of 21 cases _CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YANG Xianwei ¹ , HUANG Bin ² , QIU Yiwen ¹ , DU Chengsong ¹ , FENG Xi ¹ , WEI Yonggang ¹ , SHEN Shu ¹ , LEI Jianyong ³ , ZHANG Zhongwei ⁴ , ZHAO Jichun ² , CHEN Zheyu ¹ , LI Bo ¹ , WEN Tianfu ¹ , FAN Haining ⁵ , YANG Kangming ⁶ , WEI Gengfu ⁶ , YAN Lünan ¹ ,  WANG Wentao ¹

1. Department of Liver Surgery, West China Hospital, Sichuan University, Chengdu 610041, P.R.China;
2. Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu 610041, P.R.China;
3. Department of Thyroid Surgery, West China Hospital, Sichuan University, Chengdu 610041, P.R.China;
4. Department of Intensive Care Unit, West China Hospital, Sichuan University, Chengdu 610041, P.R.China;
5. Department of Hepatobiliary and Pancreatic Surgery, Qinghai University Affiliated Hospital, Xining 810000, P.R.China;
6. Department of Hepatobiliary Surgery, Ganzi Tibetan Autonomous Prefecture People’s Hospital, Kangding, Sichuan 626000, P.R.China;

Corresponding author：

WANG Wentao, Email: wwt02@163.com

Keywords：

hepatic alveolar echinococcosis; liver autotransplantation; ex vivo liver resection; autologous blood vessel; complication

DOI：

10.7507/1007-9424.201704040

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Objective To summarize the methods, safety, and efficacy of the ex vivo liver resection followed by autotransplantation in the treatment of advanced hepatic alveolar echinococcosis (HAE). Method A retrospective analysis of clinical data and follow-up data in 21 cases who received ex vivo liver resection followed by autotransplantation in the treatment of HAE from February 2014 to December 2016 in West China Hospital was performed. Results All the patients successfully underwent ex vivo liver resection followed by autotransplantation and no death happened during operation. The median weight of remnant liver was 701.4 g (360–1 300 g), the average operation time were 13.6 h (9.4–19.5 h), the anhepatic phase time were 180–455 min with median of 314 min. The average of intraoperative blood loss were 2 379 mL (1 200–6 000 mL). The average of patients entered red blood cell suspension were 10.6 u (0–39.5 u), the average of fresh frozen plasma were 1 377 mL (0–6 050 mL) , of which 7 patients received autologous blood transfusion, with average of 1 578 mL (500–3 700 mL). The average of postoperative hospital stay were 23.5 days (4–51 days). Postoperative complications occurred in 12 patients during hospitalization, and 4 cases of postoperative complications were in grade Clavien-Dindo Ⅲ or above, 2 cases of grade Ⅴ (died). During the follow-up period, 19 patients were followed for a median of 16.2 months (3–38 months), no HAE recurrence or metastasis was found, only 1 patient were lost follow-up after surgery for 12 months. Massive ascites and hyponatremia were found in 1 patient who was diagnosis as left hepatic vein stenosis at the end of the 3 months after operation. The patient was cured after interventional treatment of hepatic vein stent implantation and angioplasty. Conclusions The ex vivo liver resection followed by autotransplantation provides radical treatment for patients with advanced HAE, but the surgery is difficult and has high risk of postoperative complications. The detailed preoperative evaluation, intraoperative pipeline reconstruction reasonably, and fine postoperative management can improve the patient’s survival, and reduce the rate of complications.

Citation： YANG Xianwei, HUANG Bin, QIU Yiwen, DU Chengsong, FENG Xi, WEI Yonggang, SHEN Shu, LEI Jianyong, ZHANG Zhongwei, ZHAO Jichun, CHEN Zheyu, LI Bo, WEN Tianfu, FAN Haining, YANG Kangming, WEI Gengfu, YAN Lünan, WANG Wentao. Ex vivo liver resection followed by autotransplantation in the treatment of advanced hepatic alveolar echinococcosis: a report of 21 cases . CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(6): 685-690. doi: 10.7507/1007-9424.201704040 Copy

1.	Craig PS, Li T, Qiu J, et al. Echinococcosis and Tibetan communities. Emerg Infect Dis, 2008, 14(10): 1674-1675.
2.	Pichlmayr R, Grosse H, Hauss J, et al. Technique and preliminary results of extracorporeal liver surgery (bench procedure) and of surgery on the in situ perfused liver. Br J Surg, 1990, 77(1): 21-26.
3.	Oldhafer KJ, Lang H, Schlitt HJ, et al. Long-term experience after ex situ liver surgery. Surgery, 2000, 127(5): 520-527.
4.	Gruttadauria S, Marsh JW, Bartlett DL, et al. Ex situ resection techniques and liver autotransplantation: last resource for otherwise unresectable malignancy. Dig Dis Sci, 2005, 50(10): 1829-1835.
5.	Wen H, Dong JH, Zhang JH, et al. Ex vivo liver resection followed by autotransplantation for end-stage hepatic alveolar echinococcosis. Chin Med J (Engl), 2011, 124(18): 2813-2817.
6.	Jianyong L, Jingcheng H, Wentao W, et al. Ex vivo liver resection followed by autotransplantation to a patient with advanced alveolar echinococcosis with a replacement of the retrohepatic inferior vena cava using autogenous vein grafting: a case report and literature review. Medicine (Baltimore), 2015, 94(7): e514.
7.	Wen H, Dong JH, Zhang JH, et al. Ex vivo liver resection and autotransplantation for end-stage alveolar echinococcosis: a case series. Am J Transplant, 2016, 16(2): 615-624.
8.	吐尔洪江·吐逊, 阿卜杜萨拉木·艾尼, 李玉鹏, 等. 非原位肝切除技术安全性、可行性和有效性的系统评价. 中华医学杂志, 2016, 96(28): 2251-2257.
9.	Kern P, Wen H, Sato N, et al. WHO classification of alveolar echinococcosis: principles and application. Parasitol Int, 2006, 55 Suppl: S283-S287.
10.	Shi ZR, Yan LN, Li B, et al. Evaluation of standard liver volume formulae for Chinese adults. World J Gastroenterol, 2009, 15(32): 4062-4066.
11.	Lei JY, Wang WT, Yan LN. Risk factors of SFSS in adult-to-adult living donor liver transplantation using the right liver: a single-center analysis of 217 cases. Hepatogastroenterology, 2012, 59(117): 1491-1497.
12.	Clavien PA, Petrowsky H, DeOliveira ML, et al. Strategies for safer liver surgery and partial liver transplantation. N Engl J Med, 2007, 356(15): 1545-1559.
13.	Kishi Y, Abdalla EK, Chun YS, et al. Three hundred and one consecutive extended right hepatectomies: evaluation of outcome based on systematic liver volumetry. Ann Surg, 2009, 250(4): 540-548.
14.	李富贵, 严律南, 李波, 等. 中国成人标准肝体积评估公式的临床研究. 四川大学学报(医学版), 2009, 40(2): 302-306.
15.	Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg, 2009, 250(2): 187-196.
16.	Vuitton DA, Zhou H, Bresson-Hadni S, et al. Epidemiology of alveolar echinococcosis with particular reference to China and Europe. Parasitology, 2003, 127 Suppl: S87-S107.
17.	Deplazes P, Rinaldi L, Alvarez Rojas CA, et al. Global distribution of alveolar and cystic echinococcosis. Adv Parasitol, 2017, 95: 315-493.
18.	Craig PS; Echinococcosis Working Group in China. Epidemiology of human alveolar echinococcosis in China. Parasitol Int, 2006, 55 Suppl: S221-S225.
19.	中国医师协会外科医师分会包虫病外科专业委员会. 肝两型包虫病诊断与治疗专家共识 (2015 版). 中华消化外科杂志, 2015, 14(4): 253-264.
20.	Du C, Liu Z, Yang X, et al. Hepatectomy for patients with alveolar echinococcosis: long-term follow-up observations of 144 cases. Int J Surg, 2016, 35: 147-152.
21.	Ammann RW, Fleiner-Hoffmann A, Grimm F, et al. Long-term mebendazole therapy may be parasitocidal in alveolar echinococcosis. J Hepatol, 1998, 29(6): 994-998.
22.	Vuitton D. Alveolar echinococcosis of the liver: a parasitic disease in search of a treatment. Hepatology, 1990, 12(3 Pt 1): 617-618.
23.	Li F, Yang M, Li B, et al. Initial clinical results of orthotopic liver transplantation for hepatic alveolar echinococcosis. Liver Transpl, 2007, 13(6): 924-926.
24.	夏天, 严律南. 肝移植治疗肝泡状棘球蚴病. 中国普外基础与临床杂志, 2005, 12(2): 132-134.
25.	吐尔干艾力·阿吉, 邵英梅, 赵晋明, 等. 肝泡型包虫病自体肝移植中提升功能肝" 量与质”的临床实践: 附12例临床病例分析. 中华医学杂志, 2017, 97(4): 270-275.
26.	叶啟发. 论自体肝移植的关键技术. 中国普外基础与临床杂志, 2015, 22(12): 1422-1424.
27.	Momii S, Koga A. Time-related morphological changes in cold-stored rat livers. A comparison of Euro-Collins solution with UW solution. Transplantation, 1990, 50(5): 745-750.
28.	张胜, 周杰, 谭永法, 等. 肝移植术后腹腔大出血的相关因素分析. 广东医学, 2012, 33(6): 770-772.

1. Craig PS, Li T, Qiu J, et al. Echinococcosis and Tibetan communities. Emerg Infect Dis, 2008, 14(10): 1674-1675.
2. Pichlmayr R, Grosse H, Hauss J, et al. Technique and preliminary results of extracorporeal liver surgery (bench procedure) and of surgery on the in situ perfused liver. Br J Surg, 1990, 77(1): 21-26.
3. Oldhafer KJ, Lang H, Schlitt HJ, et al. Long-term experience after ex situ liver surgery. Surgery, 2000, 127(5): 520-527.
4. Gruttadauria S, Marsh JW, Bartlett DL, et al. Ex situ resection techniques and liver autotransplantation: last resource for otherwise unresectable malignancy. Dig Dis Sci, 2005, 50(10): 1829-1835.
5. Wen H, Dong JH, Zhang JH, et al. Ex vivo liver resection followed by autotransplantation for end-stage hepatic alveolar echinococcosis. Chin Med J (Engl), 2011, 124(18): 2813-2817.
6. Jianyong L, Jingcheng H, Wentao W, et al. Ex vivo liver resection followed by autotransplantation to a patient with advanced alveolar echinococcosis with a replacement of the retrohepatic inferior vena cava using autogenous vein grafting: a case report and literature review. Medicine (Baltimore), 2015, 94(7): e514.
7. Wen H, Dong JH, Zhang JH, et al. Ex vivo liver resection and autotransplantation for end-stage alveolar echinococcosis: a case series. Am J Transplant, 2016, 16(2): 615-624.
8. 吐尔洪江·吐逊, 阿卜杜萨拉木·艾尼, 李玉鹏, 等. 非原位肝切除技术安全性、可行性和有效性的系统评价. 中华医学杂志, 2016, 96(28): 2251-2257.
9. Kern P, Wen H, Sato N, et al. WHO classification of alveolar echinococcosis: principles and application. Parasitol Int, 2006, 55 Suppl: S283-S287.
10. Shi ZR, Yan LN, Li B, et al. Evaluation of standard liver volume formulae for Chinese adults. World J Gastroenterol, 2009, 15(32): 4062-4066.
11. Lei JY, Wang WT, Yan LN. Risk factors of SFSS in adult-to-adult living donor liver transplantation using the right liver: a single-center analysis of 217 cases. Hepatogastroenterology, 2012, 59(117): 1491-1497.
12. Clavien PA, Petrowsky H, DeOliveira ML, et al. Strategies for safer liver surgery and partial liver transplantation. N Engl J Med, 2007, 356(15): 1545-1559.
13. Kishi Y, Abdalla EK, Chun YS, et al. Three hundred and one consecutive extended right hepatectomies: evaluation of outcome based on systematic liver volumetry. Ann Surg, 2009, 250(4): 540-548.
14. 李富贵, 严律南, 李波, 等. 中国成人标准肝体积评估公式的临床研究. 四川大学学报(医学版), 2009, 40(2): 302-306.
15. Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg, 2009, 250(2): 187-196.
16. Vuitton DA, Zhou H, Bresson-Hadni S, et al. Epidemiology of alveolar echinococcosis with particular reference to China and Europe. Parasitology, 2003, 127 Suppl: S87-S107.
17. Deplazes P, Rinaldi L, Alvarez Rojas CA, et al. Global distribution of alveolar and cystic echinococcosis. Adv Parasitol, 2017, 95: 315-493.
18. Craig PS; Echinococcosis Working Group in China. Epidemiology of human alveolar echinococcosis in China. Parasitol Int, 2006, 55 Suppl: S221-S225.
19. 中国医师协会外科医师分会包虫病外科专业委员会. 肝两型包虫病诊断与治疗专家共识 (2015 版). 中华消化外科杂志, 2015, 14(4): 253-264.
20. Du C, Liu Z, Yang X, et al. Hepatectomy for patients with alveolar echinococcosis: long-term follow-up observations of 144 cases. Int J Surg, 2016, 35: 147-152.
21. Ammann RW, Fleiner-Hoffmann A, Grimm F, et al. Long-term mebendazole therapy may be parasitocidal in alveolar echinococcosis. J Hepatol, 1998, 29(6): 994-998.
22. Vuitton D. Alveolar echinococcosis of the liver: a parasitic disease in search of a treatment. Hepatology, 1990, 12(3 Pt 1): 617-618.
23. Li F, Yang M, Li B, et al. Initial clinical results of orthotopic liver transplantation for hepatic alveolar echinococcosis. Liver Transpl, 2007, 13(6): 924-926.
24. 夏天, 严律南. 肝移植治疗肝泡状棘球蚴病. 中国普外基础与临床杂志, 2005, 12(2): 132-134.
25. 吐尔干艾力·阿吉, 邵英梅, 赵晋明, 等. 肝泡型包虫病自体肝移植中提升功能肝" 量与质”的临床实践: 附12例临床病例分析. 中华医学杂志, 2017, 97(4): 270-275.
26. 叶啟发. 论自体肝移植的关键技术. 中国普外基础与临床杂志, 2015, 22(12): 1422-1424.
27. Momii S, Koga A. Time-related morphological changes in cold-stored rat livers. A comparison of Euro-Collins solution with UW solution. Transplantation, 1990, 50(5): 745-750.
28. 张胜, 周杰, 谭永法, 等. 肝移植术后腹腔大出血的相关因素分析. 广东医学, 2012, 33(6): 770-772.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Ex vivo liver resection followed by autotransplantation in the treatment of advanced hepatic alveolar echinococcosis: a report of 21 cases

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