Ex situ and in situ liver resection - is there still an indication?

Most liver tumors can be removed with conventional resection techniques emp loying partial or total vascular occlusion when needed. Duration of tolerab le warm ischemia has not yet been defined, but it seems to be well tolerate d up to 60 min. In a few cases with extended vascular resection and reconst ruction liver protection by hypothermic perfusion is advantageous. This can be achieved by in situ perfusion, ante situm resection or ex situ resectio n. Major reconstruction of hepatic vessels with good technical access shoul d be performed under in situ hypothermic protection using veno-venous bypas s. Tumors involving the hepatic venous confluence and/or retrohepatic vena cava should be approached by either the in situ, or preferentially, the ant e situm resection technique. The indication for an ex situ liver resection resulting in autotransplantation of the remnant liver exists only in rare c ases for oncological reasons.