BACKGROUND: Alveolar echinococcosis (AE) primarily affects the liver and potentially spreads to other organs. Managing recurrent AE poses significant challenges, especially when it involves critical structures and multiple major organs.
METHODS: We present a case of a 59-year-old female with recurrent AE affecting the liver, heart, and lungs following two previous hepatectomies, the hepatic lesions persisted, adhering to major veins, and imaging revealed additional diaphragmatic, cardiac, and pulmonary involvement. The ex vivo liver resection and autotransplantation (ELRA), first in human combined with right atrium (RA) reconstruction were performed utilizing cardiopulmonary bypass, and repairs of the pericardium and diaphragm. This approach aimed to offer a potentially curative solution for lesions previously considered inoperable without requiring a donor organ or immunosuppressants. The patient encountered multiple serious complications, including atrial fibrillation, deteriorated liver function, severe pulmonary infection, respiratory failure, and acute kidney injury (AKI). These complications necessitated intensive intraoperative and postoperative care, emphasizing the need for a comprehensive management strategy in such complicated high-risk surgeries.
CONCLUSIONS: The multidisciplinary collaboration in this case proved effective and yielded significant therapeutic outcomes for a rare case of advanced hepatic, cardiac, and pulmonary AE. The combined approach of ELRA and RA reconstruction under extracorporeal circulation demonstrated distinct advantages of ELRA in treating complex HAE. Meanwhile, assessing diaphragm function during the perioperative period, especially in patients at high risk of developing pulmonary complications and undergoing diaphragmectomy is vital to promote optimal postoperative recovery. For multi-resistant infection, it is imperative to take all possible measures to mitigate the risk of AKI if vancomycin administration is deemed necessary.

OBJECTIVE: To systematize tactical and technical aspects of liver resections with reconstruction of afferent and efferent blood supply and/or inferior vena cava; to study postoperative outcomes in patients with focal liver lesions using transplantation technologies.
METHODS: We enrolled 413 patients with parasitic lesions, primary and secondary liver tumors involving great vessels (portal vein, hepatic artery, hepatic veins, inferior vena cava, right atrium). All ones underwent liver resections with vascular resection and reconstruction, as well as liver autotransplantation in vivo, ante situ (ex situ in vivo), extracorporeal liver resections with autotransplantation (ex vivo).
RESULTS: We obtained satisfactory immediate results after liver resections using transplantation technologies.
CONCLUSIONS: Transplantation technologies in liver surgery can significantly increase resectability of tumors and survival of patients. Transplantation technologies are an important new surgical strategy and necessary option in modern hepatic surgery.
UNASSIGNED: Систематизировать тактико-технические аспекты резекций печени с резекцией и реконструкцией магистральных сосудов артериального, портального и кавального кровотока, а также нижней полой вены и изучить результаты применения трансплантационных технологий в хирургической гепатологии.
UNASSIGNED: В исследование были включены 413 пациентов. Показаниями к оперативному вмешательству были злокачественные новообразования и альвеококкоз печени, вовлекающие магистральные сосуды печени (печеночную артерию, воротную вену, печеночные вены, в том числе гепатокавальный конфлюэнс, нижнюю полую вену, вплоть до поражения правого предсердия). Всем пациентам выполнены резекции печени с резекцией и реконструкцией магистральных сосудов с применением трансплантационных технологий, в том числе аутотрансплантации печени in vivo, ante situ (ex situ in vivo), экстракорпоральные резекции печени с аутотрансплантацией (ex vivo).
UNASSIGNED: Показаны удовлетворительные непосредственные и отдаленные результаты выполнения обширных резекций печени с сосудистыми реконструкциями с использованием трансплантационных технологий.
UNASSIGNED: Применение трансплантационных технологий в хирургии печени, в том числе с применением тотальной сосудистой изоляции печени в условиях нормо- или гипотермии позволяет существенно увеличить резектабельность и повлиять на выживаемость пациентов с новообразованиями печени. Трансплантационные технологии являются важной новой хирургической стратегией и необходимой опцией в современной гепатохирургии.

To systematize technical aspects of liver resections with reconstruction of afferent and efferent liver blood supply and/or inferior vena cava, as well as to analyze the results of surgical treatment in patients with focal liver lesions.
The study included 413 patients with parasitic lesions, primary and secondary liver tumors with great vessel invasion (portal vein, hepatic artery, hepatic veins, inferior vena cava, right atrium). These features excluded radical liver resections without vascular resection and reconstruction, as well as liver autotransplantation in vivo, liver autotransplantation ante situ (ex situ in vivo), extracorporeal liver resections with autotransplantation (ex vivo).
Surgical interventions were systematized depending of surgical tactics and techniques, technical complexity, type and number of reconstructed vessels, the use of total vascular isolation and cold preservation techniques, resection and reconstruction of great vessels. Thus, 4 gradations were allocated (Grade I-IV). The definition of transplantation technologies in liver surgery was proposed.
Transplantation technologies in liver surgery include liver resections supplemented with vascular reconstruction of afferent and efferent liver blood supply, inferior vena cava including total vascular isolation of liver under normo- or hypothermia. These measures can significantly extend the possibilities of resection.
Систематизировать тактико-технические аспекты резекций печени с реконструкцией афферентного и эфферентного кровоснабжения печени и/или нижней полой вены и изучить результаты хирургического лечения пациентов с очаговыми образованиями печени.
Исследование проведено среди 413 пациентов с паразитарными, первичными и вторичными новообразованиями печени с инвазией магистральных сосудов (воротная вена, печеночная артерия, печеночные вены, нижняя полая вена, правое предсердие), что исключало возможность выполнения радикальных резекций печени без сосудистой резекции и реконструкции, а также аутотрансплантации печени in vivo, аутотрансплантации печени ante situ (ex situ in vivo), экстракорпоральных резекций печени с аутотрансплантацией (ex vivo).
Хирургические вмешательства систематизированы в зависимости от применения различных тактико-технических приемов, технической сложности, вида и количества реконструируемых сосудов, применения методики тотальной сосудистой изоляции и холодовой консервации, использованной техники при резекции и реконструкции магистральных сосудов, технической сложности оперативных вмешательств, в результате чего выделены 4 градации (Grade I—IV). Предложено определение трансплантационных технологий в резекционной хирургии печени.
К трансплантационным технологиям в хирургии печени следует относить резекции печени, дополненные сосудистым реконструктивным компонентом путей афферентного и эфферентного кровоснабжения печени, а также нижней полой вены, в том числе с применением тотальной сосудистой изоляции печени в условиях нормо- или гипотермии, которые позволяют существенно увеличить резектабельность.

BACKGROUND: Retrohepatic inferior vena cava (RIVC) resection without reconstruction in ex vivo liver resection and autotransplantation (ERAT) for advanced alveolar echinococcosis (HAE) is unclear.
METHODS: This is a retrospective study of consecutive patients referred to our hospital from 2014 to 2018. Depending on the presence of a rich collateral circulation and stable blood volume in ERAT, patients did not rebuild the RIVC. Then, patients were selected some appropriate revascularization techniques for the hepatic and renal veins. Finally, all ERAT procedures were completed, and short- and long-term outcomes were observed.
RESULTS: Five advanced HAE patients underwent ERAT without RIVC reconstruction. One patient died of circulatory failure 1 day after surgery. Another four patients, with a median follow-up duration of 18 months (range, 10-25 months), demonstrated normal liver and kidney function, no thrombosis and no HAE recurrence.
CONCLUSIONS: Through the long-term results of ERAT, the pros and cons of not reconstructing the RIVC need to be re-examined. In cases with a rich collateral circulation, the RIVC cannot be reconstructed. However, in cases requiring the resection of multiple organs, RIVC without reconstruction was prudential.

暂无摘要。

BACKGROUND: The University of Wisconsin (UW) and histidine-tryptophan-ketoglutarate (HTK) solutions are the two most frequently used liver graft preservation fluids. The present study aimed to compare their efficacy in end-stage hepatic alveolar echinococcosis patients who underwent ex-situ liver resection and autotransplantation (ELRA).
METHODS: A total of 81 patients received ELRA from August 2010 to March 2018. They were allocated into UW (n = 48) and HTK groups (n = 33) based on the type of solutions used. Demographic and operational data were retrospectively analyzed. Primary outcomes included 90-day mortality, incidence of early graft loss, primary dysfunction, and postoperative complications.
RESULTS: Demographic and operational characteristics were similarly distributed in the two groups. No statistically significant differences were observed with regard to 90-day mortality (12.77% vs. 12.12%) and early graft loss rate (8.51% vs. 9.09%) between the two groups. Patients in the UW and HTK groups showed a primary dysfunction rate of 27.66% and 27.27%, respectively. The UW group exhibited a higher incidence tendency of biliary complications, albeit with no statistical significance.
CONCLUSIONS: This is the largest cohort study comparing the efficacy of the UW and HTK organ-preserving solutions in end-stage hepatic alveolar echinococcosis patients in ELRA settings. UW and HTK solutions presented similar efficacy and safety. A randomized clinical trial with larger scale is needed for further investigation in future clinical applications.

OBJECTIVE: To evaluate the value of the three-dimensional visualization technology for the preoperative assessment of liver autotransplantation for end-stage hepatic alveolar echinococcosis.
METHODS: A total of 8 patients with end-stage hepatic alveolar echinococcosis undergoing liver autotransplantation in Qinghai Provincial People\'s Hospital from May 2013 to July 2017 were collected. All cases received preoperative abdominal CT scanning and dynamic three-phase enhanced CT scanning, and the original CT data were transferred to the human 3D visualization virtual surgical planning system. The volumes of Echinococcus multilocularis and pre-resected liver were measured using the 3D visualization reconstruction, and the relationship between the lesion and the neighboring tissues was observed. The value of the 3D visualization technology for the preoperative assessment of liver autotransplantation for end-stage hepatic alveolar echinococcosis was assessed by comparing with the intraoperative findings.
RESULTS: The 3D visualization reconstruction model clearly displayed the adjacent relationship between the lesions of end-stage hepatic alveolar echinococcosis and the neighboring tissues, and no significant difference was seen between the pre-resected liver volume in 3D visualization reconstruction model and the actually resected liver volume (t = 1.083, P > 0.05).
CONCLUSIONS: 3D visualization technology is feasible to develop a reasonable scheme for liver resection and vascular anastomosis for end-stage hepatic alveolar echinococcosis prior to liver autotransplantation, which may increase the success of surgery and improve the prognosis.
[摘要] ［摘要］目的 探讨三维可视化技术在终末期肝多房棘球蚴病患者行自体肝移植术前评估中的应用价值。方法 收集 2013 年 5 月至 2017 年 7 月在青海省人民医院接受自体肝移植术的 8 例终末期肝多房棘球蚴病患者。对8 例患者术前行腹部 CT 平扫及三期动态增强扫描, 将患者 CT 原始数据传输至人体三维可视化虚拟手术系统, 通过三维可视化重建测定多房棘球绦虫体积、预切肝体积, 并观察病灶与周围组织的关系。对比术中实际所见, 评估三维可视化技术对终末期肝多房棘球蚴病行自体肝移植术的应用价值。结果 三维可视化重建模型能清晰显示终末期肝多房棘球蚴病病灶与周围组织毗邻关系, 三维可视化重建模型术前测得预切肝体积与术中实际切除的肝体积差异无统计学意义 (t = 1.083, P > 0.05)。结论 三维可视化技术可用于终末期肝多房棘球蚴病行自体肝移植术前制定合理的肝脏切除及血管吻合方案, 提高手术成功率、改善患者预后。.

A solitary fibrous tumor (SFT) is a rare mesenchymal tumor. Ex situ hepatectomy and liver autotransplantation are novel methods for the treatment of complicated liver tumors, for example, those involving vascular structures, including the inferior vena cava, which are unresectable by conventional approaches. The present study describes a rare case of a massive hepatic SFT in a 32-year-old female who underwent ex situ hepatectomy and liver autotransplantation to achieve a radical resection. The surgery was without complications. Post-operative histopathological and immunohistochemical examinations revealed an SFT of the liver. The patient was discharged 29 days after the surgery with fully recovered liver function. The routine check-up 3 months after surgery indicated normal liver function and no evidence of recurrence. Additionally, an exhaustive review of available literature was performed to provide a complete overview of the current status of SFTs. In summary, the present study found that ex situ hepatectomy and liver autotransplantation are suitable surgical techniques for treating a giant SFT, as well as other liver neoplasms that are considered unresectable by conventional surgery.

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.