• Abudusalamu Aini, Qian Lu, Zhiyu Chen, Zhanyu Yang, Zhipeng Liu, Leida Zhang, and Jiahong Dong.
• Hepatopancreatobiliary Center, Organ Transplantation Center, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China.
• Ann. Surg. 2024 Aug 15.

ObjectiveTo assess the effectiveness of optimized ex-vivo liver resection and autotransplantation (ELRA) for treating liver malignancies.Summary Background DataELRA is a promising surgery for radical resection of conventionally unresectable tumors, despite the disappointing long-term prognosis during its' developmental stages. A recent multicenter study reported 5-year overall and disease-free survival rates (OS, DFS) of 28% and 20.8%, respectively.MethodsWe retrospectively analyzed data of patients who underwent ELRA for advanced liver cancers between 2009 and 2022. We applied ELRA via our novel surgical indication classification system where the surgical risk with curative intent for advanced liver malignancy was controllable using the ex-vivo approach. The ELRA was optimized for determinacy, predictability, and controllability via the precision liver surgery paradigm (PLS).ResultsThirty-seven cases with liver malignancies were enrolled. The operative time and anhepatic phase duration were 649.6±200.0 and 261.2±74.5 min, respectively, while the intraoperative blood loss was 1902±1192 mL. Negative resection margins were achieved in all patients, and the 90-day morbidity at Clavien-Dindo IIIa/IIIb and mortality rates were 27.0% and 24.3%. Post-ELRA 1-, 3-, and 5-year actual OS rates were 62.2%, 37.8%, and 35.1%, respectively, and 1-, 3-, and 5-year actual DFS were 43.2%, 24.3%, and 18.9%, respectively.ConclusionsLong-term outcomes of ELRA under the PLS for advanced liver malignancy were favorable. Appropriate criteria for disease selection & surgical indications and optimized procedures together can improve surgical treatment and patient prognosis.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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