Effect of “<i>in situ</i> first” <i>ex vivo</i> liver resection and autologous liver transplantation for end stage hepatic alveolar echinococcosis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YANG Wenhao ¹ , LIAO Yubo ² , HUANG Liang ² , WU Gang ³ , JIANG Jipeng ³ , LIAO Dongxu ³ ,  YANG Chong ⁴ ,  ZHANG Yu ³

1. School of Medicine, University of Electronic Science and Technology of China, Chengdu 610054, P. R. China;
2. Department of Clinical Medicine, Chengdu Medical College, Chengdu 610500, P. R. China;
3. Affiliated Hospital of University of Electronic Science and Technology of China ? Department of Hepatobiliary and Pancreatic Surgery, Sichuan Provincial People’s Hospital, Chengdu 610072, P. R. China;
4. Affiliated Hospital of University of Electronic Science and Technology of China ? Organ Transplantation Center of Sichuan Provincial People’s Hospital, Chengdu 610072, P. R. China;

Corresponding?author：

YANG Chong, Email: yangchong@uestc.edu.cn; ZHANG Yu, Email: 68532815@qq.com

Keywords：

in situ first; ex vivo liver resection and autologous liver transplantation; advanced hepatic alveolar echinococcosis

DOI：

10.7507/1007-9424.202206057

Video：

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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.

Citation： YANG Wenhao, LIAO Yubo, HUANG Liang, WU Gang, JIANG Jipeng, LIAO Dongxu, YANG Chong, ZHANG Yu. Effect of “in situ first” ex vivo liver resection and autologous liver transplantation for end stage hepatic alveolar echinococcosis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(10): 1308-1312. doi: 10.7507/1007-9424.202206057 Copy

1.	Yang C, Yang HJ, Deng SP, et al. Current status of ex-vivo liver resection and autologous liver transplantation for end-stage hepatic alveolar echinococcosis. Ann Palliat Med, 2020, 9(4): 2271-2278.
2.	Yang X, Qiu Y, Huang B, et al. Novel techniques and preliminary results of ex vivo liver resection and autotransplantation for end-stage hepatic alveolar echinococcosis: a study of 31 cases. Am J Transplant, 2018, 18(7): 1668-1679.
3.	Aji T, Dong JH, Shao YM, et al. Ex vivo liver resection and autotransplantation as alternative to allotransplantation for end-stage hepatic alveolar echinococcosis. J Hepatol, 2018, 69(5): 1037-1046.
4.	張宇, 楊沖, 王燚, 等. 離體肝切除和自體肝移植聯合復雜肝靜脈重建治療終末期肝泡型包蟲病. 中國普外基礎與臨床雜志, 2018, 25(10): 1236-1241.
5.	田明武, 張宇, 鄧紹平, 等. 異體血管重建肝靜脈流出道在離體肝切除并自體肝移植術中的運用體會. 中國普外基礎與臨床雜志, 2020, 27(7): 861-866.
6.	四川省包蟲病臨床醫學研究中心, 四川省醫師協會包蟲病專業委員會. 復雜肝泡型包蟲病診療專家共識(2020版). 中國普外基礎與臨床雜志, 2020, 27(1): 18-23.
7.	Zhang Y, Xie P, Yang C, et al. The value of hepatic vein stent placement as a bridge therapy on treating hepatic alveolar echinococcosis presenting with Budd-Chiari syndrome. Ann Surg, 2021, 273(4): e154-e156. doi: 10.1097/SLA.0000000000004648.
8.	Zhang Y, Yang C, Yang H, et al. Comment on “The Value of Hepatic Vein Stent Placement as a Bridge Therapy on Treating Hepatic Alveolar Echinococcosis Presenting With Budd-Chiari Syndrome”. Ann Surg, 2021, 274(6): e923-e924. doi: 10.1097/SLA.0000000000004874.
9.	Aini A, Shao Y, Shalayiadang P, et al. Auxiliary partial autologous liver transplantation for high-selective alveolar echinococcosis: a proof of concept. Transplantation, 2020, 104(5): e138-e139. doi: 10.1097/TP.0000000000003092.
10.	張宇, 楊沖, 王燚, 等. 原位保留部分殘余肝臟的離體肝切除聯合輔助性自體肝移植治療復雜肝泡型包蟲病. 中國普外基礎與臨床雜志, 2019, 26(8): 974-979.
11.	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.
12.	Zhang Y, Xie P, Yang C, et al. Percutaneous stenting of left hepatic vein followed by ex vivo liver resection and autotransplantation in a patient with hepatic alveolar echinococcosis with Budd-Chiari syndrome. Int J Surg Case Rep, 2020, 68: 251-256.
13.	Zhang Y, Lai ECH, Yang C, et al. In situ reconstruction of vascular inflow/outflow to left lateral liver section, ex-vivo liver resection and autologous liver transplantation of remaining liver remnant for hepatic alveolar echinococcosis. Int J Surg Case Rep, 2020, 69: 39-43.
14.	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.
15.	Wang H, Liu Q, Wang Z, et al. Clinical outcomes of ex vivo liver resection and liver autotransplantation for hepatic alveolar echinococcosis. J Huazhong Univ Sci Technolog Med Sci, 2012, 32(4): 598-600.
16.	楊沖, 楊洪吉, 鄧紹平, 等. 剩余肝體積不足的晚期肝泡型包蟲外科治療進展, 中國普通外科雜志, 2021, 30(1): 98-104.
17.	Tang JC, Suolang WJ, Yang C, et al. Monosegmental ALPPS combined with ante-situm liver resection: a novel strategy for end-stage hepatic alveolar echinococcosis. Hepatobiliary Pancreat Dis Int, 2022, 21(2): 186-189.

1. Yang C, Yang HJ, Deng SP, et al. Current status of ex-vivo liver resection and autologous liver transplantation for end-stage hepatic alveolar echinococcosis. Ann Palliat Med, 2020, 9(4): 2271-2278.
2. Yang X, Qiu Y, Huang B, et al. Novel techniques and preliminary results of ex vivo liver resection and autotransplantation for end-stage hepatic alveolar echinococcosis: a study of 31 cases. Am J Transplant, 2018, 18(7): 1668-1679.
3. Aji T, Dong JH, Shao YM, et al. Ex vivo liver resection and autotransplantation as alternative to allotransplantation for end-stage hepatic alveolar echinococcosis. J Hepatol, 2018, 69(5): 1037-1046.
4. 張宇, 楊沖, 王燚, 等. 離體肝切除和自體肝移植聯合復雜肝靜脈重建治療終末期肝泡型包蟲病. 中國普外基礎與臨床雜志, 2018, 25(10): 1236-1241.
5. 田明武, 張宇, 鄧紹平, 等. 異體血管重建肝靜脈流出道在離體肝切除并自體肝移植術中的運用體會. 中國普外基礎與臨床雜志, 2020, 27(7): 861-866.
6. 四川省包蟲病臨床醫學研究中心, 四川省醫師協會包蟲病專業委員會. 復雜肝泡型包蟲病診療專家共識(2020版). 中國普外基礎與臨床雜志, 2020, 27(1): 18-23.
7. Zhang Y, Xie P, Yang C, et al. The value of hepatic vein stent placement as a bridge therapy on treating hepatic alveolar echinococcosis presenting with Budd-Chiari syndrome. Ann Surg, 2021, 273(4): e154-e156. doi: 10.1097/SLA.0000000000004648.
8. Zhang Y, Yang C, Yang H, et al. Comment on “The Value of Hepatic Vein Stent Placement as a Bridge Therapy on Treating Hepatic Alveolar Echinococcosis Presenting With Budd-Chiari Syndrome”. Ann Surg, 2021, 274(6): e923-e924. doi: 10.1097/SLA.0000000000004874.
9. Aini A, Shao Y, Shalayiadang P, et al. Auxiliary partial autologous liver transplantation for high-selective alveolar echinococcosis: a proof of concept. Transplantation, 2020, 104(5): e138-e139. doi: 10.1097/TP.0000000000003092.
10. 張宇, 楊沖, 王燚, 等. 原位保留部分殘余肝臟的離體肝切除聯合輔助性自體肝移植治療復雜肝泡型包蟲病. 中國普外基礎與臨床雜志, 2019, 26(8): 974-979.
11. 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.
12. Zhang Y, Xie P, Yang C, et al. Percutaneous stenting of left hepatic vein followed by ex vivo liver resection and autotransplantation in a patient with hepatic alveolar echinococcosis with Budd-Chiari syndrome. Int J Surg Case Rep, 2020, 68: 251-256.
13. Zhang Y, Lai ECH, Yang C, et al. In situ reconstruction of vascular inflow/outflow to left lateral liver section, ex-vivo liver resection and autologous liver transplantation of remaining liver remnant for hepatic alveolar echinococcosis. Int J Surg Case Rep, 2020, 69: 39-43.
14. 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.
15. Wang H, Liu Q, Wang Z, et al. Clinical outcomes of ex vivo liver resection and liver autotransplantation for hepatic alveolar echinococcosis. J Huazhong Univ Sci Technolog Med Sci, 2012, 32(4): 598-600.
16. 楊沖, 楊洪吉, 鄧紹平, 等. 剩余肝體積不足的晚期肝泡型包蟲外科治療進展, 中國普通外科雜志, 2021, 30(1): 98-104.
17. Tang JC, Suolang WJ, Yang C, et al. Monosegmental ALPPS combined with ante-situm liver resection: a novel strategy for end-stage hepatic alveolar echinococcosis. Hepatobiliary Pancreat Dis Int, 2022, 21(2): 186-189.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Effect of “in situ first” ex vivo liver resection and autologous liver transplantation for end stage hepatic alveolar echinococcosis

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