EX vivo liver resection and auto transplantation for a giant hepatocellular carcinoma: A case report

Abstract

Introduction and importance: The curative options for locally advanced hepatocellular carcinomas involving the vessels are very limited. Ex vivo liver resection and auto transplantation (ERAT) is a novel surgical method, which has been used in the management of such complex liver space occupying lesions, which are rendered conventionally unresectable. This technique involves a complete hepatectomy, extracorporeal hepatic resection on the backbench, and then reimplantation of the remnant hepatic parenchyma. George et al. (2019) [1] In literature, Ex vivo liver resection and auto transplantation (ERAT) has been utilized in the management of both benign and malignant liver lesions, including hepatocellular carcinoma (HCC), cholangiocarcinoma, hepatic metastases, hepatic alveolar echinococcosis, focal nodular hyperplasia and hemangioma. Zawistowski et al. (2020) [2].

Case presentation: We report this case of a 28 years old male with a giant hepatocellular carcinoma, that deemed unresectable as it was closely abutting all three hepatic veins. After appropriate preoperative surgical planning, he underwent ex vivo liver resection and autotransplantation (ERAT). Patient had gradual uneventful recovery and he was discharged home on 12th postoperative day.

Clinical discussion: A radical (R0) resection is the main goal of the ex vivo liver resection and autotransplantation (ERAT) procedure, which can be used for curative intent in patients with liver lesions that are conventionally inoperable. It allows for precise extracorporeal resection, maximizes the residual liver volume and increases the likelihood of obtaining negative margins. Furthermore, the bench surgery in ice bath makes it easier to reconstruct the vasculature without the pressure of time constraints in situ, unlike conventional surgery, which can take a long time when done in a bleeding operative field. Zawistowski et al. (2020) [2].

Conclusion: For patients with complex liver lesions believed to be incurable with conventional surgical methods, ex vivo liver resection and autotransplantation (ERAT) provides an alternative.

Keywords: Autotransplantation; Ex vivo liver resection; Hepatocellular carcinoma.