Hepatectomies under Hypothermic Perfusion of the Liver

Objective: To propose a surgical strategy guiding the total vascular exclusion (TVE) subtype during liver resection under hypothermic perfusion (LR-HypoT); to analyze the latter’s outcome futility, the risk of severe postoperative liver failure (POLF); and whether LT could have been an alternative treatment. Background: Series on LR-HypoT lack granularity, and none analyzed outcome futility or liver transplantation (LT) as an alternative treatment. Methods: Single-center retrospective analysis of 110 consecutive LR-HypoT performed between 1997 and 2024 for malignant (n=100) or benign tumors (n=10). The subtypes of TVE used, 90-D mortality, and outcome futility (90-D death or tumor recurrence within six months of surgery) were analyzed. Risk of POLF was analyzed by recursive partitioning analysis. Results: LR-HypoT was performed in situ in 108 (98.2%) patients and ex situ in 2 (1.8%). 90-D mortality was 15.5% (n=17). POLF, the leading cause of 90-D mortality (14/17, 82.3%), occurred in 32 (29%) patients. Biliary reconstruction ( P =0.023) and the need for extended hepatectomy ( P =0.033) were the two risk factors for POLF. In patients with cancer, early tumor recurrence and outcome futility rate was 17.2% and 30.0%, respectively. With a median follow-up of 100 (3-183) months, 5-years survival was 36.8%, 30.0%, and 100% for the study population, patients with malignant or benign tumors, respectively. LT criteria were not met by 92% (92/100) of patients with cancer. Conclusions: LR-HypoT can be performed in situ in most cases. In patients presenting otherwise unresectable or untransplantable malignant tumors, encouraging long-term results can be obtained in one third of patients.