Objective To explore the effect of “in situ first” ex vivo liver resection and autologous liver transplantation (ELRA) for end stage hepatic alveolar echinococcosis (HAE). Methods The clinicopathologic data of 85 end stage HAE cases were initially scheduled underwent ELRA from June 2019 to May 2022 in the Sichuan Provincial People’s Hospital were collected retrospectively. The included cases were operated under “in situ first” ERLA principle. The analyzed data included the final surgical style, operative time, time of anhepatic phase and intraoperative blood transfusion volume for ELRA cases. Results All the included 85 cases underwent radical HAE lesions resection and without perioperative death occurred. According to the principle of “in situ first”, 57 cases underwent HAE lesions resection combined vascular reconstruction without ex vivo liver resection (in situ resection group); 1 case underwent auxiliary partial autologous liver transplantation, and 27 cases underwent ERLA procedures (ELRA group). In the in situ resection group, the operative time was 210–750 min, （380±134）min, and the intraoperative blood transfusion was 0–3 250 mL with a median of 0 mL. In the ELRA group, the operative time was 450–1 445 min, (852±203) min, and the intraoperative blood transfusion was 0–6 800 mL with a median of 1 960 mL. The operative time and the amount of blood transfusion in the ELRA group were longer or more than those in the in situ resection group. The time of anhepatic phase for the ELRA group was 60–480 min, (231±83) min. On the 5th day after operation, except that the total bilirubin and direct bilirubin in the ELRA group were higher than those in the in situ resection group, the other indexes of liver function were similar between the two groups. The postoperative stay in ICU and the total postoperative hospital stay in the ELRA group were longer than those in the in situ resection group. Conclusions The advantage of “in situ first” ERLA principle for end stage HAE patients include resecting the HAE lesions radically without ex vivo liver resection and alleviating the hepatic ischemia and reperfusion injury. For the inevasible ELRA cases, “in situ first” principle could shorten the anhepatic phase and reduce intraoperative blood loss, and turn some cases to auxiliary partial autologous liver transplantation, which will reduce the risk of postoperative hepatic failure.
ObjectiveTo investigate the value of laparoscopic liver venous deprivation (LLVD) in promoting the growth of contralateral future liver remnant (FLR) during two-step hepatectomy. MethodThe clinicopathologic data of a 45-year-old female patient with pancreatic neuroendocrine tumor with multiple liver metastases (grade G2) treated by two-step hepatectomy based on LLVD in January 2022 in the Sichuan Provincial People’s Hospital were analyzed retrospectively. ResultsThe liver function returned to normal within 10 d after LLVD, and the relative increase ratio of FLR reached to 98.35% on postoperative day 10. The laparoscopic right hemi-hepatectomy and distal pancreatectomy plus splenectomy was performed without any postoperative complications, and the patient was discharged from hospital on postoperative day 8. No tumor recurrence or metastasis occurred during the follow-up period. ConclusionsFrom the analysis results of this case, the LLVD could promote the growth of FLR safely and effectively. LLVD provides an alternative surgical method of two-step hepatectomy for treatment of benign and malignant liver tumors.
ObjectiveTo explore the feasibility and safety of modified semi-ex vivo small intestinal autotransplantation (IAT) in patients with distal cholangiocarcinoma (CC) involving mesenteric root. MethodThe clinicopathologic data of the patient with relapse after CC surgery admitted to Sichuan Provincial People’s Hospital on October 2022 were retrospectively analyzed. ResultsThe patient was a 40 years old male. The preoperative imaging showed that the superior mesenteric artery (SMA) and jejunal artery was surrounded by the tumor. The preoperative condition was good and the heart, lung, liver, and kidney functions were normal. The patient could tolerate surgery, then the modified semi-ex vivo IAT was performed. The patient recovered well after surgery and discharged on the 14th postoperative day. The postoperative pathological diagnosis result showed that it was CC. The patient was well and without recurrence or metastasis during following-up in the outpatient service for 5 months until April 2023. ConclusionsFrom the retrospective analysis of this case, it can be realized that the modified semi-ex vivo IAT for patients with tumor involving themesenteric root, it is safe and feasible. A treatment option can be provided for such patient.