Surgical approaches for complex hepatic and perihepatic tumors: a single-center experience with ante situm and ex...

Ante situm and ex situ liver surgery may offer potential treatment options for patients with locally advanced hepatic and perihepatic tumors deemed unresectable by conventional techniques. However, the complexity of the procedures and historically high morbidity and mortality rates have limited their widespread adoption. This study aims to evaluate perioperative morbidity, mortality, and long-term survival outcomes following ante situm and ex situ liver surgery.

This single-center cohort study examines a consecutive series of patients who underwent ante situm and ex situ liver surgery at Oslo University Hospital between 2001 and 2023.

A total of 35 patients underwent surgery during the study period, including 19 primary cancers and 9 colorectal liver metastases. Seven patients had benign conditions, including giant hemangiomas (n = 3), hepatic venous occlusive syndrome (n = 3), and alveolar echinococcosis (n = 1). The overall 90-day mortality rate was 5.7%. Patients with benign conditions demonstrated 100% survival at 5 years. Among patients with primary tumors, survival rates at 1, 3, and 5 years were 84.2, 67.4, and 49.4%, respectively. In contrast, the survival rates for patients with metastatic cancer were 50.0% at 1 year, 37.5% at 3 years, and 0% at 5 years.

In carefully selected patients, ante situm and ex situ liver surgery provide a viable option for technically unresectable liver tumors, with manageable perioperative risks and encouraging long-term outcomes, especially for benign and primary malignancies.