Ex vivo liver resection and auto-transplantation for cholangiocarcinoma.

e16194 Background: Cholangiocarcinoma (CCA) is an epithelial malignancy with a dismal prognosis. Here, we presented our single-center experience in treating CCA using a novel surgical procedure, ex vivo liver resection and auto-transplantation (ELRA). Methods: We retrospectively enrolled 175 patients with CCA after tumor resection in our single center between September 2021 and June 2024, with the last follow-up conducted on November, 2024. The primary outcome was overall survival (OS), while the secondary outcome mainly was recurrence-free survival (RFS). We employed a 1:1 propensity score matching (PSM) approach to adjust potential confounders between the ELRA cohort and the conventional liver resection (CLR) cohort. Results: After matching, a total of 27 pairs were included in our study. In the ELRA cohort, the median RFS was 17.0 months (95% CI: 14.6 - not estimated [NE]), while the median OS was not estimated (95% CI: 25.6 - NE). Both RFS and OS were significantly longer than those observed in the CLR cohort, with P-values of 0.006 and 0.016, respectively. Univariate and multivariate Cox regression analyses revealed that ELRA was an independently factor associated with improved outcomes in both RFS (hazard ratio [HR]: 0.351 [95% CI 0.161-0.766]; P = 0.009) and OS (HR: 0.127 [95% CI 0.029-0.547]; P = 0.006). Complications related to ELRA procedures are manageable, with 19 patients (70.37%) experiencing grade 1-2 complications and 3 patients (11.11%) encountering grade 3-5 complications. Furthermore, as a surgical approach, in vivo partial hepatectomy followed by ELRA demonstrated comparable effectiveness in vivo total hepatectomy followed by ELRA (all P values > 0.05). Conclusions: ELRA was a promising method to improve outcomes for patients with CCA, particularly in cases involving vascular invasion.