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.	张宇, 杨冲, 王燚, 等. 离体肝切除和自体肝移植联合复杂肝静脉重建治疗终末期肝泡型包虫病. 中国普外基础与临床杂志, 2018, 25(10): 1236-1241.
5.	田明武, 张宇, 邓绍平, 等. 异体血管重建肝静脉流出道在离体肝切除并自体肝移植术中的运用体会. 中国普外基础与临床杂志, 2020, 27(7): 861-866.
6.	四川省包虫病临床医学研究中心, 四川省医师协会包虫病专业委员会. 复杂肝泡型包虫病诊疗专家共识(2020版). 中国普外基础与临床杂志, 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.	张宇, 杨冲, 王燚, 等. 原位保留部分残余肝脏的离体肝切除联合辅助性自体肝移植治疗复杂肝泡型包虫病. 中国普外基础与临床杂志, 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.	杨冲, 杨洪吉, 邓绍平, 等. 剩余肝体积不足的晚期肝泡型包虫外科治疗进展, 中国普通外科杂志, 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. 张宇, 杨冲, 王燚, 等. 离体肝切除和自体肝移植联合复杂肝静脉重建治疗终末期肝泡型包虫病. 中国普外基础与临床杂志, 2018, 25(10): 1236-1241.
5. 田明武, 张宇, 邓绍平, 等. 异体血管重建肝静脉流出道在离体肝切除并自体肝移植术中的运用体会. 中国普外基础与临床杂志, 2020, 27(7): 861-866.
6. 四川省包虫病临床医学研究中心, 四川省医师协会包虫病专业委员会. 复杂肝泡型包虫病诊疗专家共识(2020版). 中国普外基础与临床杂志, 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. 张宇, 杨冲, 王燚, 等. 原位保留部分残余肝脏的离体肝切除联合辅助性自体肝移植治疗复杂肝泡型包虫病. 中国普外基础与临床杂志, 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. 杨冲, 杨洪吉, 邓绍平, 等. 剩余肝体积不足的晚期肝泡型包虫外科治疗进展, 中国普通外科杂志, 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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