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Ex situ liver resection and autotransplantation for advanced cholangiocarcinoma
  1. Ashish George1,2,
  2. Ashwin Rammohan1,2,
  3. Srinivas Mettu Reddy1,2 and
  4. Mohamed Rela1,2
  1. 1 Institute of Liver Disease & Transplantation, Dr. Rela Institute & Medical Centre, Sree Balaji Medical College Hospital, Bharat Institute of Higher Education & Research, Chennai, Tamil Nadu, India
  2. 2 Institute of Liver Disease & Transplantation, Gleneagles Global Health City, Chennai, Tamil Nadu, India
  1. Correspondence to Dr Ashwin Rammohan, ashwinrammohan{at}


Advanced cholangiocarcinoma especially those involving the vasculature have extremely limited options of cure. Ex situ liver resection entails performing a total hepatectomy, resecting the tumour on the back-table followed by reimplantation (autotransplantation) of the liver. Application of this technique for these tumours has rarely been done due to complexity of the procedure and the dismal prognosis of the lesions. We present our experience of two cases of advanced intrahepatic cholangiocarcinoma with limited extrahepatic disease who underwent ex situ resection with autotransplantation. They underwent preoperative therapy with a waiting period to assess the tumour biology. Both patients underwent ex situ resection with extended hepatectomy on the back table. Both patients remain well on follow-up 24 months and 20 months, respectively, with excellent quality of life. Despite its technical complexity, ex situ liver resection may offer prolonged overall survival in selected patients with advanced cholangiocarcinoma and limited extrahepatic disease.

  • surgical oncology
  • transplantation
  • gastrointestinal surgery
  • hepatic cancer
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  • Contributors AR, AG and SMR: contributed to conception and design, acquisition, analysis and interpretation of data. All authors drafted the article and revised it critically for important intellectual content. MR: gave the final approval of the version to be published.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

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