Clinical Sdudy Of Ex Vivo Liver Resection And Autotransplantation In Liver Complex Space-occupying Lesions

BackgroundSurgery is the first choice to treat liver space-occupying lesions,especially liver malignancies.However,conventional surgical methods are often difficult to treat liver-occupying diseases with complex locations represented by central posterior tumors.Ex vivo liver resection and autotransplantation(ELRA)is a complex surgical technique that combines many difficult techniques such as liver resection,vascular reconstruction,organ cryopreservation,transplantation,etc.,and can be used to treat complicated space occupying lesion in liver.Compared with conventional surgical methods,ELRA has obvious advantages,but the perioperative mortality is high.Clinically,there is a lack of large sample observation results of ELRA treatment of liver malignancies;the long-term prognosis is unclear;comparative studies with other treatment methods have not been reported;there is a lack of detailed ELRA adaptation and contraindication standards.ObjectivesTo explore the clinical efficacy of ex vivo liver resection and autotransplantation in the treatment of complicated liver lesions.Optimize patient selection criteria and improve surgical safety.Methods1.The data of 41 patients were collected,according to the perioperative prognosis,the patients were divided into perioperative death group(9 cases),who died within 90 days after operation;survival group(32 cases),survived within 90 days after operation.Retrospective descriptive research methods were used to observe the preoperative situation,surgical situation,short-term postoperative prognosis and follow-up.Multivariate logistic regression analysis was performed on independent predictors of short-term postoperative death.Multivariate Cox regression analysis was used to analyze the factors affecting long-term survival.The Kaplan-Meier method was used to calculate the survival rate and draw the survival curve.2.Collect data of 50 patients and divide them into benign group(9 cases),suffering from benign space occupying disease in liver,and malignant group(41 cases),suffering from liver malignancies.Using retrospective descriptive research methods,we observed preoperative conditions,operative conditions,short-term prognosis after surgery,and follow-up,and compared the perioperative mortality and long-term efficacy of the two groups.3.Collect the data of 106 patients,and divide the patients into ELRA group(29 cases)according to the treatment method and receive ELRA treatment;the control group(77 cases)receive hepatic artery interventional embolization chemotherapy(TACE).Using retrospective descriptive research methods to observe the preoperative conditions,surgical conditions,short-term postoperative prognosis and follow-up conditions,the two groups of patients were compared with perioperative mortality and long-term efficacy.A 1:1 propensity score pairing(PSM)was used for the two groups of patients.The Kaplan-Meier method was used to calculate the survival rate and draw the survival curve.Results1.ELRA was successful in all 41 patients,and the R0 resection rate was 100%.The operation time was 617(422-1204)minutes,23 cases(56%)underwent complex vascular reconstruction,and 7 cases(17%)underwent cholangiojejunostomy.The survival group and the death group had statistical differences in blood loss,duration of operation,duration of anhepatic phase,cholangiojejunostomy,and arterial reconstruction variables.Biliary-enteric anastomosis(bile duct invasion)was an independent risk factor for perioperative death(OR=24.29;P=0.034).The median survival time of 41 patients was 15 months.The cumulative survival rates of 1,3,and 5 years were 63.4%,36.6%,and 31.0%,respectively.The cumulative disease-free survival rates for 1,3,and 5 years were 31.5%,21.0%,and18.0%,respectively.Multiple tumors,bile duct invasion and lymphatic metastasis are independent predictors of long-term survival2.Nine cases in the benign group,including 6 cases of hepatic hydatid disease,2 cases of hepatic hemangioma,1 case of hepatic myelolipoma;41 cases of malignant group,including 36 cases of primary liver cancer(29 cases of hepatocellular carcinoma,6 cases of intrahepatic cholangiocarcinoma and 1 case of liver cystadenocarcinoma),5 cases of metastatic liver cancer(2 cases of gastric cancer liver metastasis,1 case of colon cancer liver metastasis,1 case of pancreatic cancer liver metastasis,1 case of gallbladder cancer liver metastasis).There was no statistical difference in general clinical data such as gender,age,liver function,cirrhosis,bilirubin,and vascular invasion between the two groups of patients(P>0.05).The length of operation,residual liver marked liver ratio,Intraoperative conditions such as vascular reconstruction and bilioenteric anastomosis were also not statistically different(P>0.05).Nine patients died within 90 days after surgery,all of whom were in the malignant group.Among them,3 died of multiple organ dysfunction syndrome caused by severe infection,3 died of acute liver failure,2 died of abdominal hemorrhage,and 1 died of pulmonary artery embolism.The overall survival time of 50 patients was 17 months(1 to 119months).The 1,3,and 5-year overall survival rate and tumor-free survival rate were 68.0%,45.9%,41.1% and 41.9%,33.4%,30.8%,respectively The survival time of patients in the benign group was 68 months(10-114 months),and the overall survival rate and disease-free survival rate of 1,3,and 5 years were 88.9%.The overall survival rate of patients in the benign group and the malignant group was compared,and the difference was statistically significant(P=0.006).3.According to PSM analysis,29 pairs of patients were obtained.There was no statistical difference in variables such as general condition,liver condition,and tumor-related condition between the two groups(all p> 0.1).The median survival time in the ELRA group was 15 months,and the median survival time in the intervention group was 11 months(p=0.039).The 90-day mortality rate of the two groups was 13.8%(4/29)and 7.0%(2/29),respectively.The 1,3,and 5-year cumulative survival rates of the two groups were 72.4,34.5,30.7% and 44.8,13.8,and 6.9%,respectively.Conclusions1.It is feasible to use ELRA to treat liver disease that is difficult to remove by conventional surgery.A considerable part of patients undergoing this operation can obtain satisfactory long-term survival.2.Patients with malignant tumors with major bile duct invasion(bilioenteric anastomosis)have an increased risk of perioperative death after ELRA.3.The safety and long-term efficacy of ELRA in the treatment of benign liver masses are better than its use in liver malignant tumors.The indications and contraindications of ELRA surgery for benign and malignant diseases should be formulated separately.4.The long-term efficacy of ELRA is better than TACE,and patients should be fully informed of the advantages and disadvantages of various treatment methods in order to maximize the benefits of patients.