A Translational Approach to Standardization of Machine Perfusion Adoption in Ex Vivo Liver Resection

Autor: Riccardo Boetto, Michela Di Giunta, Enrico Gringeri, Pasquale Auricchio, Umberto Cillo, M. Polacco, Francesco D'Amico, Luca Perin, Domenico Bassi, Roberto Luisetto
Rok vydání: 2020
Předmět:
Zdroj: Annals of Surgical Oncology. 27:1919-1919
ISSN: 1534-4681
1068-9265
DOI: 10.1245/s10434-019-08163-4
Popis: BACKGROUND Hepatic resection represents the best treatment for primary and metastatic liver tumors but is not always feasible. In early 1980, Piclmayr described a complex liver resection technique, termed "ex vivo liver resection," for the treatment of locally advanced tumors not conventionally resectable. The authors approached this technique with translational research in a preclinical setting and then similarly reproduced it in human patients. METHODS In the swine median xyphopubic laparotomy, the liver was mobilized to expose the vena cava. A temporary porto-caval shunt was previously prepared on the back table using a segment of thoracic aorta, and a vascular anastomosis between the supra-hepatic vena cava and a caval graft was quickly performed. The liver was placed in a machine perfusion system and continuously perfused for 2 h for its final implantation orthotopically in the same animal. The anastomoses were performed as usual. Based on this experience, the intervention was reproduced in the human model of a 39-year-old woman affected by large intrahepatic cholangiocarcinoma considered unresectable.' RESULTS All animals survived the procedure. The peak aspartate aminotransferase level (460 ± 87 U/L) was recorded 60 min after reperfusion. Lactate levels flared up for 120 min (3.6 ± 0.2 mmol/L). In the clinical case, the postoperative period was uneventful, and the patient was discharged on day 22. CONCLUSIONS The described procedure is feasible only for surgeons with a transplantation background. The study showed that this translational approach enhances the surgeon's ability to perform the intervention systematically in a shorter time and with a good outcome.
Databáze: OpenAIRE
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