Radical Hepatectomy Versus Ex Vivo Liver Resection And Autotransplantation For Advanced Hepatic Alveolar Echinococcosis

Objective: The aim of this study was to compare the clinical outcomes of radical hepatectomy and ex vivo liver resection and autotransplantation(ERAT)in patients suffering advanced hepatic alveolar echinococcosis(HAE).Methods:From January 2017 to February 2020,82 patients with advanced HAE fulfilled the inclusion criteria(radical hepatectomy group,n = 52;ERAT group,n = 30).Each group was assessed for indications,complications,shortand long-term outcomes..Results:The intraoperative mortality was zero in both groups.Two patients died after ERAT due to intra-abdominal bleeding and acute liver failure.The most frequent postoperative complications were pleural effusion,biliary complications and hepatic insufficiency.The incidence of major complications in ERAT group was higher than that in radical hepatectomy group(P=0.044).No recurrence was found in both groups.The survival curve showed that there was no significant difference in survival time between ERAT group and radical hepatectomy group(P=0.159).The 1-year and 3-year survival rates of the radical hepatectomy group were both 95.9%.The 1-year and 3-year survival rates of the ERAT group were 90.6% and 85.2%,respectively.Conclusion: Compared with radical hepatectomy,the incidence of major complications is higher in patients after ERAT,but there is no significant difference in survival time between the two groups.Radical hepatectomy is the first choice for the treatment of HAE,but ERAT is a safe and effective treatment for advanced patients who cannot undergo radical resection.The application of “in vivo firstly” principle is important for ERAT.