Hypothermic oxygenated machine perfusion in non-transplant liver surgery: a polled, comparative and quantitative study.

BACKGROUND

In-situ, ante-situm, ex-situ liver resections under hypothermic perfusion (HP) are expanding tumor resectability as they could allow for 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.