Extracorporeal Liver Surgery Emerges as Viable Option for Previously Inoperable Liver Conditions

A comprehensive review published online December 19, 2024, in Hepatobiliary & Pancreatic Diseases International details how Chinese surgeons have transformed extracorporeal liver surgery into a viable solution for patients with locally advanced liver tumors or invasive parasitic disease who were historically classified as surgically unresectable. The multi-institutional analysis documents three major surgical approaches that have set new global benchmarks: ex-situ liver resection and autotransplantation, ante-situm liver resection and autotransplantation, and auxiliary partial liver autotransplantation. These techniques address limitations of conventional hepatectomy when tumors invade critical vascular structures, where even advanced techniques like total vascular exclusion and in-situ hypothermic perfusion often fail to secure radical and safe resections.

Chinese surgical teams pioneered numerous technical refinements that have dramatically improved patient outcomes. They developed the nonuse of veno-venous bypass technique to stabilize hemodynamics during the anhepatic phase, created novel vascular reconstruction strategies to preserve future liver remnant vasculature, and introduced umbilical vein recanalization to secure portal perfusion. These innovations have simplified complex operations while significantly reducing perioperative risks. The systematic classification of indications for both liver malignancies and alveolar echinococcosis has enabled surgeons to better select appropriate candidates and guide surgical decision-making.

Clinical outcomes demonstrate the effectiveness of these approaches, with five-year overall survival rates exceeding 35% for selected liver malignancies and reaching 80% for alveolar echinococcosis cases. Precision planning using three-dimensional imaging, functional liver volume equations, and virtual surgery has further enhanced predictability and safety. Professor Jia-Hong Dong, a pioneer in the field, emphasized that what was once experimental has become a refined and standardized procedure capable of achieving surgical cure for patients previously labeled as inoperable. The integration of advanced imaging, surgical precision, and multi-disciplinary teamwork has eliminated traditional boundaries in treating complex liver disease.

The impact extends beyond surgical technique, as extracorporeal liver surgery eliminates the need for donor grafts and lifelong immunosuppression, providing a practical lifeline for patients with otherwise untreatable conditions. While liver transplantation offers an alternative pathway, donor organ shortages and lifelong immunosuppression risks make this approach impractical for many patients. As international centers adopt methods pioneered in China, including nonuse of veno-venous bypass strategies and innovative autograft reimplantation patterns, the field anticipates broader global adoption. Future integration with interventional radiology, systemic therapies, and regenerative medicine could further expand indications and improve outcomes for patients worldwide. The full review is available at https://doi.org/10.1016/j.hbpd.2024.12.005.