FAQ: Extracorporeal Liver Surgery (ELS) - Resecting Previously Unresectable Liver Tumors

What is Extracorporeal Liver Surgery (ELS) and what problem does it solve?

ELS is an advanced surgical technique that addresses the challenge of locally advanced liver tumors or invasive parasitic diseases previously considered ‘unresectable’ when conventional hepatectomy fails due to tumor invasion into critical vascular structures.

Why were certain liver tumors previously considered unresectable?

Tumors were deemed unresectable when they invaded the hepato-caval confluence, major hilar vessels, or both, making even total vascular exclusion and in-situ hypothermic perfusion insufficient for safe radical resections.

What are the three main categories of ELS procedures described in the review?

The three major surgical categories are ex-situ liver resection and autotransplantation (ELRA), ante-situm liver resection and autotransplantation (ALRA), and auxiliary partial liver autotransplantation (APLA).

How have Chinese surgeons improved ELS procedures?

Chinese teams pioneered innovations including the nonuse of veno-venous bypass technique to stabilize hemodynamics, novel vascular reconstruction strategies, umbilical vein recanalization for portal perfusion, and refined patient selection criteria.

What are the survival outcomes for patients undergoing ELS?

Clinical data show five-year overall survival rates over 35% for selected liver malignancies and 80% for alveolar echinococcosis patients treated with ELS procedures.

How does ELS compare to liver transplantation as a treatment option?

ELS offers advantages over liver transplantation by avoiding the shortage of donor organs and eliminating the need for lifelong immunosuppression, making it more practical for many patients.

What technologies support the precision planning in ELS?

Precision planning utilizes three-dimensional imaging, functional liver volume equations, and virtual surgery to enhance predictability and safety of the procedures.

Where was the research on ELS advancements published?

The review was published online December 19, 2024, in Hepatobiliary & Pancreatic Diseases International (DOI: 10.1016/j.hbpd.2024.12.005).

What conditions are most suitable for ELS treatment?

ELS is particularly indicated for patients with locally advanced liver tumors and alveolar echinococcosis who cannot be treated with conventional hepatectomy but can benefit from radical resection with organ preservation.