[Ex vivo liver resection with autotransplantation for initially unresectable colorectal liver metastases: a systematic review].

Objective

To investigate the feasibility and efficacy of ex vivo liver resection and autologous liver transplantation (ERAT) in the treatment of initially unresectable colorectal cancer liver metastases (CRLM).

Methods

Four databases, including PubMed, Embase, Scopus and Web of Science, were systematically searched for literature on ERAT for CRLM published from database inception to May 13, 2025. Meanwhile, clinical data of CRLM patients who underwent ERAT at the Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine between 2021 and 2024 were collected. Perioperative conditions and prognosis of the patients were summarized.

Results

(1) Literature review: A total of 13 patients with CRLM who underwent ERAT from 5 studies were included. Among the 9 patients with available margin status, 8 achieved R0 resection and 1 underwent R1 resection. Among cases with available complication data, postoperative complications occurred in 7 patients, including pleural effusion in 3 patients. Other complications included infectious bile leakage, small bowel perforation, and inferior vena cava obstruction or compression. One patient died on postoperative day 15 due to acute respiratory failure and renal failure secondary to hemopneumothorax. Overall survival ranged from 15 days to 76 months. Among patients with available follow-up data, tumor recurrence occurred in 3 patients, including 1 patient with confirmed bone metastasis, while the sites of recurrence in the remaining patients were not clearly reported. (2) Institutional experience: All 5 patients in our center achieved R0 resection. One patient died of acute liver failure postoperatively, and the remaining cases recovered well. Pleural effusion occurred in all patients postoperatively, but the length of hospital stay did not exceed 3 weeks in any case. One patient had early postoperative recurrence and died at 27 months, while the other 3 patients remained alive at the last follow-up(2025/9/30).

Conclusions

ERAT may serve as a potential surgical option for selected patients with unresectable CRLM, and radical resection can be expected under strict patient selection criteria.