Int J Surg. 2025 Jun 20. doi: 10.1097/JS9.0000000000002790. Online ahead of print.
ABSTRACT
BACKGROUND: In-situ, ante-situm, ex-situ liver resections under hypothermic perfusion (HP) are expanding tumor resectability as they could allow extensive hepatectomies and intricate vascular reconstructions. Meanwhile, hypothermic oxygenated machine perfusion (HOPE) has been well-established in liver transplantation, showing improved graft and patient outcomes. However, the quality of surgical treatment using HOPE in these non-transplant liver surgeries remains unproven.
MATERIALS AND METHODS: An exhaustive literature research and polled analysis to study the efficacy of HOPE for in-situ, ante-situm, ex-situ liver resections for hepatic malignancies were performed. Considering the sufficiency of reported data, the ante-situm liver resection under HOPE for intrahepatic cholangiocarcinoma was selected to make comparisons focusing on perioperative surgical outcome and long-term oncological outcomes. Control groups were ante-situm liver resection under conventional HP and ante-situm liver resection without conventional HP (relying on total vascular exclusion, TVE).
RESULTS: Three publications, reporting two case reports and one case series report, were identified with seven cases altogether. Generally, median hospital stay was 17 (12-30) days, 90-day severe complications occurred 14.3% (1/7) patients, no 90-day mortality was observed, median survival was 14.5 (6-34) months. Median hospital stay, 90-day severe complication and mortality rates of ante-situm approach under HOPE (n = 5) were better than conventional HP (n = 6) or TVE approaches (n = 6) [17 (12-30) vs. 26.5 (16-70) vs. 28 (20-54), 20% vs. 50% vs. 33.3%, 0% vs. 16.7% vs. 16.7%; no statistical significance]; however, 6-month recurrence rate was higher (60% vs. 0% vs. 20%), restricted mean recurrence-free survival was shorter [6.6 (95%CI: 3.6-9.2) vs. 9.1 (95%CI: 5.5-11) vs. 8.7 (95%CI: 4.8-12.7)], and restricted mean overall survival showed insignificance.
CONCLUSIONS: Although HOPE may improve perioperative outcomes of in-situ, ante-situm, ex-situ liver resections, current evidence suggests suboptimal oncological results of ante-situm approach under HOPE, highlighting the need for further refinement.
PMID:40540312 | DOI:10.1097/JS9.0000000000002790
