Ex vivo liver resection and autotransplantation for hepatic alveolar echinococcosis with cavernous transformation of the portal vein.

BACKGROUND

Ex vivo liver resection and autotransplantation (ELRA) offers new therapeutic perspectives and possibilities for R0 resection in patients with hepatic alveolar echinococcosis (AE) combined with cavernous transformation of the portal vein (CTPV).

METHODS

We analyzed 49 hepatic AE patients with CTPV treated at our center from January 2010 to June 2023. We compared the different outcomes with different treatments for the 49 patients: ELRA for 12 and conservative for 9 patients. After propensity score matching, we compared the ELRA treatment outcomes for 12 patients with CTPV and 24 patients without CTPV. Kaplan-Meier analysis was used to compare overall survival, and Cox regression to identify factors influencing postoperative survival.

RESULTS

In the ELRA cohort, both CTPV and non-CTPV patients had no intraoperative mortality; 90-day mortality rate for both groups was 16.7% (2/12 in CTPV patients and 4/24 in non-CTPV patients). Pleural effusion was the most common postoperative complication. CTPV patients required significantly longer operative time and more intraoperative blood transfusions (P < 0.05). However, no significant difference was observed in long-term overall survival between CTPV and non-CTPV patients after ELRA (71.4% vs. 74.5%, P > 0.05). In the CTPV cohort, patients who underwent ELRA had significantly better long-term survival compared to those who did not receive surgery (72.9% vs. 29.6%, P < 0.05). Extrahepatic AE disease, rather than CTPV, was identified as an independent risk factor for postoperative survival (P < 0.05).

CONCLUSIONS

ELRA is a safe and effective approach for hepatic AE patients with CTPV, significantly improving long-term survival. CTPV itself does not negatively impact postoperative survival, further emphasizing the benefits of this procedure in this particular population.