Chinese Surgical Innovations Transform Treatment for Previously Inoperable Liver Conditions

A new review published online December 19, 2024, in Hepatobiliary & Pancreatic Diseases International reveals how Chinese surgical teams have transformed extracorporeal liver surgery from an experimental procedure into a standardized treatment for patients with complex liver conditions previously deemed surgically unresectable. The article, available at https://doi.org/10.1016/j.hbpd.2024.12.005, details how these advances provide new hope for patients with locally advanced liver tumors or invasive parasitic diseases who previously had only palliative options.

Conventional hepatectomy remains the gold standard for many liver tumors but reaches its limits when tumors invade critical vascular structures like the hepato-caval confluence or major hilar vessels. Even advanced techniques like total vascular exclusion and in-situ hypothermic perfusion often fail to secure safe, radical resections in these complex cases. Liver transplantation offers an alternative but faces significant limitations including donor organ shortages and the risks of lifelong immunosuppression, making it impractical for many patients.

Chinese surgeons have developed three major surgical approaches that constitute modern extracorporeal liver surgery: ex-situ liver resection and autotransplantation, ante-situm liver resection and autotransplantation, and auxiliary partial liver autotransplantation. These procedures involve temporarily removing the liver, performing complex tumor resections outside the body, and then reimplanting the remaining healthy liver tissue. Early attempts at such bench resections carried daunting complication rates, but Chinese teams have systematically refined the techniques to improve safety and outcomes.

The innovations include pioneering the nonuse of veno-venous bypass technique to stabilize patient hemodynamics during the anhepatic phase, developing novel vascular reconstruction strategies to preserve future liver remnant vasculature, and introducing umbilical vein recanalization to secure portal perfusion. These technical refinements have simplified operations while reducing perioperative risks. Perhaps most importantly, surgeons have developed classification systems for both liver malignancies and alveolar echinococcosis that enable better patient selection, guide surgical decision-making, and improve outcome predictability.

The clinical results demonstrate the transformative potential of these advances. For carefully selected patients, five-year overall survival rates now exceed 35% for liver malignancies and reach 80% for alveolar echinococcosis. Precision planning using three-dimensional imaging, functional liver volume equations, and virtual surgery has further enhanced both predictability and safety. According to Professor Jia-Hong Dong, a pioneer in the field, these developments represent one of the most ambitious frontiers in hepatobiliary practice. What was once experimental is now a refined and standardized procedure that can achieve surgical cure for patients previously labeled as inoperable.

The impact extends well beyond technical surgical achievements. By eliminating the need for donor grafts and lifelong immunosuppression, extracorporeal liver surgery has become a practical lifeline for patients with otherwise untreatable disease. As international centers adopt methods pioneered in China, including NVVB strategies and innovative autograft reimplantation patterns, the field is positioned for broader global adoption. The integration of extracorporeal liver surgery with interventional radiology, systemic therapies, and regenerative medicine could further expand indications and improve outcomes. Establishing global registries and consensus frameworks will be crucial to ensuring this once-daring, now-proven surgery achieves its full potential worldwide.