Liver Autotransplantation from the Labs to the Ante-situm Procedure: A Long Journey

Abstract

The use of liver transplantation techniques, including interventional radiology techniques, complete liver vascular control, and liver preservation technique, has contributed to current management of patients with involvement of the inferior vena cava by hepatic tumors or those with large centrally located lesions or lesions in close proximity to the confluence of the inferior vena cava and hepatic veins, which would otherwise be deemed unresectable. The training of hepatobiliary surgeons must include a familiarity with all such techniques and formal training in liver transplantation. Appropriate decision-making for formal resections in patients who have been treated with systemic neoadjuvant therapies and then require subsequent surgical care is based on a mandatory evaluation of massive lobar or multilobar tumor involvement and intra- or retro-hepatic venous neoplastic lesions. The transfer of the patient to a transplant center is the gold standard for centers that lack the surgical and medical expertise of transplant referral centers. Technical skills in advanced hepatobiliary surgery, patient hemodynamics and resuscitation, diagnostic multidisciplinary evaluations, operative indications by grade of tumor extension, selection criteria for surgical management, and criteria for the choice of operation are mandatory for indicating formal liver resection as initial therapy and/or excision of tumors of the caval confluence and/or all three hepatic veins.