Ex vivo liver resection and autotransplantation following transarterial chemoembolization and stereotactic body radiation therapy for advanced hepatocellular carcinoma

Ex vivo liver resection and autotransplantation (ELRAT) is a technically demanding yet increasingly viable option for the treatment of otherwise unresectable tumors with vascular involvement. We describe the case of a 50-year-old female diagnosed with an extensive hepatocellular carcinoma involving the retrohepatic inferior vena cava (IVC) and major hepatic veins, deemed unresectable. After undergoing transarterial chemoembolization and stereotactic body radiation therapy, which resulted in significant tumor necrosis, reduction in lesion size, and a substantial decline in alpha-fetoprotein levels, the patient subsequently underwent ELRAT with IVC reconstruction. Although postoperative complications occurred, such as an incisional hernia and IVC stenosis that necessitated stent insertion, she has remained free of recurrence 24 months following surgery, demonstrating the potential of preoperative therapy to enhance ELRAT outcomes.