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

Abstract / Summary

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. 目的： 探讨离体肝切除联合自体肝移植（ERAT）治疗初始不可切除的结直肠癌肝转移（CRLM）的可行性及效果。 方法： 系统检索PubMed、Embase、Scopus和Web of Science 4个数据库，从建库到2025年5月13日发表的有关ERAT治疗CRLM的文献；同时，收集2021—2024年期间浙江大学医学院附属第二医院肝胆胰外科行ERAT治疗CRLM患者的临床资料；总结患者围手术期情况以及预后情况。 结果： （1）文献分析情况：共纳入5项研究报道的13例接受ERAT治疗的CRLM患者。在报道切缘状态的9例患者中，8例获得R0切除，1例为R1切除。在可获得并发症资料的病例中，7例患者发生术后并发症，其中胸腔积液3例，其他并发症包括感染性胆漏、小肠穿孔及下腔静脉梗阻或受压。1例患者因血气胸引发急性呼吸衰竭和肾衰竭，在术后15 d死亡。患者总生存期范围15 d至76个月。随访资料可获得的病例中，3例患者出现肿瘤复发，其中1例确诊骨转移，其余复发部位未见详细报道。（2）本中心患者情况：本中心5例患者均实现R0切除，1例因术后急性肝功能衰竭死亡，其余病例恢复良好。所有患者术后均出现胸腔积液，但住院时间均未超过3周。1例患者术后早期复发并于27个月死亡，其余3例患者至随访终点（2025年9月30日）仍存活。 结论： ERAT可作为部分不可切除CRLM患者的潜在手术选择，在严格筛选条件下有望实现根治性切除。.

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