Impact of Multimodal Fast-Track Protocols on Recovery in End-Stage Hepatic Alveolar Echinococcosis Patients Undergoing ex vivo Liver Resection and Autotransplantation: a Preliminary Study

Yan Qin,1 Jiafei Li,2 Qiuping Ren2,3 1Operating Room of West China Hospital/West China School of Nursing, Sichuan University, Chengdu, People’s Republic of China; 2West China School of Nursing, Sichuan University, Chengdu, People’s Republic of China; 3Division of Liver Surgery, Department of General Surgery, West China Hospital, Chengdu, People’s Republic of ChinaCorrespondence: Qiuping Ren, Email [email protected]: While ex vivo liver resection combined with autotransplantation has been reported from various perspectives, the use of fast-track protocols for this procedure in treating end-stage hepatic alveolar echinococcosis has not been documented.Methods: We retrospectively analyzed the outcomes of 21 patients with end-stage hepatic alveolar echinococcosis who underwent ex vivo liver resection and autotransplantation, followed by a fast-track recovery protocol at our institution between 2014 and 2017.Results: All patients successfully underwent liver autotransplantation with no intraoperative mortality. Postoperative hospital stays ranged from 4 to 51 days, with an average of 23.5 days. Hospital costs averaged $3 million (range $1.94– 4.07 million). Twelve patients experienced postoperative complications, with four classified as Clavien-Dindo grade III or higher. Two patients died due to intra-abdominal bleeding and acute cerebral hemorrhage, respectively. Nineteen patients were followed for a median of 16.2 months (range 3– 38 months), with no recurrence of hepatic alveolar echinococcosis.Conclusion: Fast-track protocols are safe and effective in the context of ex vivo liver resection and autotransplantation.Keywords: fast-track surgery, autotransplantation, ex vivo resection