Ex situ liver resection for unresectable tumors.

Primary and secondary liver tumors are among the most common tumors in humans. Two surgical approaches may be used to address these tumors: liver transplantation and liver resection. However, some tumors cannot be treated by conventional techniques or liver transplantation due to poor intraoperative exposure, limitations of indication standards, and/or other complex factors. To overcome these problems, ex situ liver resection has been introduced and used successfully in many cases. This technique is based primarily on liver transplantation and perfusion with preservation solution under hypothermic conditions. The major indications for ex situ liver resection are liver tumors that are unresectable or in which resection using conventional surgical techniques is very dangerous due to the close proximity to or involvement of the venous confluence and/or the main hepatic veins. However, high mortality and morbidity rates limit the use of this technique despite the efforts of many surgeons to improve their skills. Patient selection is of utmost importance to achieve a good outcome. Emphasis on basic research (e.g. on reperfusion injury) and the development of key techniques should improve the safety of the procedure and reduce mortality in the future.