Ex-vivo resection techniques in tissue-preserving surgery for liver malignancies

Some primary and secondary liver tumours are not absolutely irresectable, b ut cannot be resected using a conventional approach because of the limited warm ischaemia tolerance of the liver or poor accessibility of the tumour r egion. In such situations, the techniques of ex vivo liver surgery, pioneer ed by Rudolf Pichlmayr some 10 years ago, offer new chances for RO resectio n. All the three different approaches, namely "in situ"-, "ante situm"-, an d "ex situ" resection, require the use of measures originally developed for transplantation, such as hypothermic liver perfusion and veno-venous bypas s. They differ mainly in the extent to which major vessels are divided in o rder to achieve optimal mobility of the organ. The results show that radica l re section can be achieved accomplished in many cases. If necessary, comp lex vascular reconstructions can be performed. Although perioperative morbi dity and mortality are high, there are a number of longterm survivors. Tumo ur recurrence, however, remains the main problem over the long term. In con clusion, ex vivo liver surgery is an important extension of surgical treatm ent possibilities. However, the procedure is suitable only for a small numb er of carefully selected patients and should be reserved for use in special ised centres. Furthermore, in view of the fact that the results are not yet optimal, additive and adjuvant treatment modalities are needed.