ObjectiveTo explore the safety and efficacy of preoperative liver regeneration and then two-stage liver resection for advanced hepatic alveolar echinococcosis (HAE) patients pre-evaluating insufficient future liver remnant (FLR) after resection. MethodThe clinical data of the advanced HAE patients who were expected to have insufficient FLR after liver resection and underwent two-step liver resection in the Sichuan Provincial People’s Hospital from December 2016 to December 2022 were retrospectively collected and summarized. ResultsA total of 11 patients with advanced HAE pathologically confirmed were collected. Among them, 2 cases underwent portal vein embolization (PVE), 2 cases underwent liver vein deprivation (LVD), and 7 cases underwent associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) to promote residual liver regeneration in the first stage. The FLR/standard liver volume (SLV) exceeded the surgical requirement standard of 40%. Then the ex-vivo liver resection and autotransplantation, or directly radical liver resection was performed in the second stage. Only one patient underwent surgery to remove packed gauze on day 3 postoperatively due to massive intraoperative bleeding (approximately 4 000 mL). The median (P25, P75) follow-up time after surgery was 36 (15, 75) months, only one case was found to relapse at the third year after surgery and underwent surgical resection again, and the rest patients had no recurrence, long-term complications, or death. ConclusionsBased on the results from these cases, applying PVE, LVD, or ALPPS in the patients with advanced HAE who were expected to have insufficient FLR after resection aids to residual liver regeneration, creating conditions for the second stage radical resection. The second stage treatment including ex-vivo liver resection and autotransplantation or directly radical liver resection could achieve good results and is feasible and safe, which brings a hope of survival for the advanced HAE patients who could not previously undergo curative resection. However, this treatment strategy still incurs high costs and requires further optimization in the future.
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.