In this paper, researchers provided the biggest American collective experience using ex vivo resection procedures for otherwise irresectable liver cancers. Recent technological advancements in situ resection and vascular repair have allowed for R0 resectioning previously incurable liver cancers. However, due to concerns about technical complexity and arterial thrombosis, ex vivo liver resection still needs to be utilized, even though it may further broaden the boundaries of resectability. They contended, however, that the knowledge base necessary for ex vivo liver resection is larger, and the consequences are less severe than are commonly believed, making ex vivo resection a more appealing choice in certain cases. Between 1997 and 2021, they looked back at 35 cases handled by surgical teams with extensive ex vivo liver resection experience (defined as having completed 4 or more such procedures). Altogether, they classified malignancies as either high-grade (n=18), intermediate-grade (n=14), or low-grade (n=3). Partial liver autotransplantation was performed after total hepatectomy, vascular reconstruction, and resection were performed in hypothermia on the backtable for each patient. There was a median survival time of 710 days and an overall survival rate of 67% (39%/28% at 1/3/5 years, respectively) (range: 22–4824). Median survival times for patients with highly aggressive, moderately aggressive, and low-grade cancers were 577 days (range: 22-3873), 444 days (range: 22-4824), and 1,825 days (range: 0-6 years), respectively (range: 868–3549). Adapting methods used in partial liver transplantation showed that ex vivo resection can have reasonably positive outcomes. Accordingly, they argued that hospitals with experience in partial liver transplantation might benefit from more liberally employing this approach for some patients.
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