<i>Ex vivo</i> Liver Resection and Autotransplantation as Radical Alternative to Sorafenib for Conventionally Unresectable Advanced-Stage Hepatocellular Carcinoma Without Portal Vein Invasion

Abstract

Background and Aims: Although sorafenib can prolong survival by 2.8 months in patients with advanced-stage hepatocellular carcinoma (HCC), radical hepatectomy is still the best treatment. However, R0 resection is difficult to achieve by conventional hepatectomy for those patients. The aim of this study was to assess the clinical outcomes of ex vivo liver resection and autotransplantation (ELRA) for conventionally unresectable HCC and establish a possible patient selection strategy. Methods: In this prospective study, 33 consecutive patients with conventionally unresectable advanced-stage HCC given ELRA and 499 that of patients administrated sorafenib were analyzed. The feasibility, safety, short- and long-term clinical outcome of this technique were assessed. Results: After analysis, the median overall survival (OS) of those patients with portal vein invasion given ELRA was only 3.87 months, lower than that of patients administrated sorafenib (6.5/10.7 months). For all patients without portal vein invasion, the median OS was 16.2 months, higher than that of patients administrated sorafenib. The 90-day mortality was 4.55%, and the 1-, 3-, and 5-year OS rates were 81.82%, 45.45% and 36.36%, respectively. Patients are considered candidates for ELRA could be defined as follows: the hepatic lesion scope (1)simultaneously involves two or more areas of the first, second and third porta hepatis; (2)involves the second porta hepatis only, but ≥ 2 main branches of major vessels were invaded; (3)involves the second porta hepatis only, but major vessels are damaged, the adhesions being difficult to separate. Results were verified by previous case reports. Conclusion: ELRA could be an effective radical treatment for patients with conventionally unresectable advanced-stage HCC without portal vein invasion. Careful patient selection is crucial for ELRA. Funding Information: There is no financial support. Declaration of Interests: The authors declare no potential conflict of interest. Ethics Approval Statement: The retrospective study design and the management of patients who underwent ELRA were in accordance with the 1975 Declaration of Helsinki and approved by the Human Ethics Committee of Southwest Hospital. Written informed consent, in which the risks of this major procedure were detailed, including prolonged hospitalization, severe debility, decrease in patient quality of life and risk of death, was obtained from all subjects and/or legal custodians. All patients and/or legal custodians consented with full understanding of the risks and benefits of the procedure.