评估优化的离体肝切除和自体移植（ELRA）治疗肝脏恶性肿瘤的有效性。ELRA 是一种有前途的手术，用于根治传统不可切除的肿瘤，尽管其发展阶段的长期预后令人失望。最近的一项多中心研究报道，5 年总生存率和无病生存率 (OS、DFS) 分别为 28% 和 20.8%。我们回顾性分析了 2009 年至 2022 年间因晚期肝癌接受 ELRA 的患者数据。我们应用 ELRA通过我们新颖的手术适应症分类系统，其中使用离体方法可以控制晚期肝脏恶性肿瘤的手术风险和治疗目的。通过精准肝脏手术范例 (PLS) 对 ELRA 的确定性、可预测性和可控性进行了优化。纳入了 37 例肝脏恶性肿瘤病例。手术时间和无肝期持续时间分别为 649.6±200.0 和 261.2±74.5 分钟，术中失血量为 1902±1192 mL。所有患者均实现了阴性切除切缘，Clavien-Dindo IIIa/IIIb 的 90 天发病率和死亡率分别为 27.0% 和 24.3%。 ELRA 后 1 年、3 年和 5 年实际 OS 率分别为 62.2%、37.8% 和 35.1%，1 年、3 年和 5 年实际 DFS 分别为 43.2%、24.3% 和分别为 18.9%。PLS 下的 ELRA 治疗晚期肝脏恶性肿瘤的长期结果良好。疾病选择的适当标准

To assess the effectiveness of optimized ex-vivo liver resection and autotransplantation (ELRA) for treating liver malignancies.ELRA is a promising surgery for radical resection of conventionally unresectable tumors, despite the disappointing long-term prognosis during its' developmental stages. A recent multicenter study reported 5-year overall and disease-free survival rates (OS, DFS) of 28% and 20.8%, respectively.We retrospectively analyzed data of patients who underwent ELRA for advanced liver cancers between 2009 and 2022. We applied ELRA via our novel surgical indication classification system where the surgical risk with curative intent for advanced liver malignancy was controllable using the ex-vivo approach. The ELRA was optimized for determinacy, predictability, and controllability via the precision liver surgery paradigm (PLS).Thirty-seven cases with liver malignancies were enrolled. The operative time and anhepatic phase duration were 649.6±200.0 and 261.2±74.5 min, respectively, while the intraoperative blood loss was 1902±1192 mL. Negative resection margins were achieved in all patients, and the 90-day morbidity at Clavien-Dindo IIIa/IIIb and mortality rates were 27.0% and 24.3%. Post-ELRA 1-, 3-, and 5-year actual OS rates were 62.2%, 37.8%, and 35.1%, respectively, and 1-, 3-, and 5-year actual DFS were 43.2%, 24.3%, and 18.9%, respectively.Long-term outcomes of ELRA under the PLS for advanced liver malignancy were favorable. Appropriate criteria for disease selection & surgical indications and optimized procedures together can improve surgical treatment and patient prognosis.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.