Abstract
Background. Ex situ liver surgery allows liver resection and vascular reconstruction in patients
who have liver tumors located at critical sites. Only a small series of studies about
ex situ liver surgery is available in the literature. No long-term results have been
published. Methods. Twenty-four patients were considered for ex situ liver surgery because conventional
liver surgery was considered impossible or too hazardous. The patients' ages were
51.3 ± 7.5 years. Indications were various primary and secondary liver malignancies
and benign liver tumors in 2 patients. Results. In 22 of 24 patients, the ex situ liver resection and subsequent autotransplantation
were performed. The anhepatic periods in these patients lasted for 5.6 ± 1.1 hours.
In the remaining 2 patients, autotransplantation was not possible and allogenic liver
transplantation was performed 17 and 19 hours after hepatectomy. In 4 patients, liver
failure occurred after autotransplantation and required transplantation. The confluens
between hepatic veins and the inferior vena cava was reconstructed in 5 patients.
Fifteen patients survived the postoperative period and were discharged after 36.5
± 16 days. The median survival time of 6 patients who had metastases of colonic carcinoma
was 21 months. The 2 patients with benign liver disease are alive 9 and 5 years after
ex situ surgery. Conclusions. Extended liver resections with difficult reconstructions of the hepatic venous confluens
are feasible by ex situ liver surgery and subsequent autotransplantation. However,
the early postoperative mortality rate is high, especially in patients with cholestatic
livers. Early tumor recurrence remained the problem in these patients with extended
local tumor spread. Ex situ liver surgery should only be performed in selected patients.
(Surgery 2000;127:520–7.)
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Article info
Publication history
Accepted:
January 1,
2000
Footnotes
*Reprint requests: Prof Karl J. Oldhafer, MD, Klinik und Poliklinik für Allgemein-und Transplantationschirurgie, Universitätsklinikum Essen, Hufelandstraβe 55, 45122 Essen, Germany.
**Surgery 2000;127:520–7
Identification
Copyright
© 2000 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
