{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T08:46:44Z","timestamp":1793263604836,"version":"4.5.0"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,11,30]],"date-time":"2021-11-30T00:00:00Z","timestamp":1638230400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["81770566"],"award-info":[{"award-number":["81770566"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004829","name":"Department of Science and Technology of Sichuan Province","doi-asserted-by":"publisher","award":["2019YFS0029"],"award-info":[{"award-number":["2019YFS0029"]}],"id":[{"id":"10.13039\/501100004829","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100013365","name":"West China Hospital, Sichuan University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100013365","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:p><jats:bold>Background:<\/jats:bold> This retrospective study aimed to evaluate the safety and learning curve of <jats:italic>ex vivo<\/jats:italic> liver resection and autotransplantation (ELRA).<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> A total of 102 consecutive end-stage HAE patients who underwent ELRA between 2014 and 2020 in West China Hospital were enrolled. The primary endpoint was major postoperative complications (comprehensive complication index, CCI &amp;gt; 26). The ELRA learning curve was evaluated using risk-adjusted cumulative sum (RA-CUSUM) methods. The learning phases were determined based on RA-CUSUM analysis and tested for their association with intra- and post-operative endpoints.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> The median surgery time was 738 (659\u2013818) min, with a median blood loss of 2,250 (1,600\u20133,000) ml. The overall incidence of major morbidity was 38.24% (39\/102). Risk-adjusted cumulative sum analysis demonstrated a learning curve of 53 ELRAs for major postoperative complications. The learning phase showed a significant association with the hemodynamic unstable time (HR \u221230.29, 95% CI \u221243.32, \u221217.25, <jats:italic>P<\/jats:italic> &amp;lt; 0.0001), reimplantation time (HR \u221213.92, 95% CI \u221223.17, \u22124.67, <jats:italic>P<\/jats:italic> = 0.004), total postoperative stay (HR \u22126.87, 95% CI \u221211.33, \u22122.41, <jats:italic>P<\/jats:italic> = 0.0033), and postoperative major morbidity (HR 0.25, 95% CI 0.09, 0.68, <jats:italic>p<\/jats:italic> = 0.007) when adjusted for age, disease course, liver function, and remote metastasis.<\/jats:p><jats:p><jats:bold>Discussion:<\/jats:bold><jats:italic>Ex vivo<\/jats:italic> liver resection and autotransplantation is feasible and safe with a learning curve of 53 cases for major postoperative complications.<\/jats:p>","DOI":"10.3389\/fsurg.2021.753968","type":"journal-article","created":{"date-parts":[[2021,12,1]],"date-time":"2021-12-01T15:51:39Z","timestamp":1638373899000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":9,"title":["Learning Curve of Ex Vivo Liver Resection and Autotransplantation in Treating End-Stage Hepatic Alveolar Echinococcosis: A RA-CUSUM Analysis"],"prefix":"10.3389","volume":"8","author":[{"given":"Yiwen","family":"Qiu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xianwei","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tao","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shu","family":"Shen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bin","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wentao","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,11,30]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1016\/bs.apar.2016.09.002","article-title":"Echinococcosis: control and prevention","volume":"96","author":"Craig","year":"2017","journal-title":"Adv Parasitol."},{"key":"B2","doi-asserted-by":"publisher","first-page":"e3866","DOI":"10.1136\/bmj.e3866","article-title":"Diagnosis, treatment, and management of echinococcosis","volume":"344","author":"McManus","year":"2012","journal-title":"BMJ."},{"key":"B3","doi-asserted-by":"publisher","first-page":"628","DOI":"10.1097\/00000658-199611000-00007","article-title":"Surgical treatment in proximal bile duct cancer. A single-center experience","volume":"224","author":"Pichlmayr","year":"1996","journal-title":"Ann Surg."},{"key":"B4","doi-asserted-by":"publisher","first-page":"2177","DOI":"10.1007\/s00423-021-02093-0","article-title":"The technical aspects of ex vivo hepatectomy with autotransplantation: a systematic review and meta-analysis","volume":"406","author":"Baimas-George","year":"2021","journal-title":"Langenbecks Arch Surg."},{"key":"B5","first-page":"113","article-title":"Working to overcome the global impact of neglected tropical diseases\u2014summary: introduction","volume":"86","year":"2011","journal-title":"Weekly Epidemiol Rec"},{"key":"B6","doi-asserted-by":"publisher","first-page":"924","DOI":"10.1002\/lt.21187","article-title":"Initial clinical results of orthotopic liver transplantation for hepatic alveolar echinococcosis","volume":"13","author":"Li","year":"2007","journal-title":"Liver Transpl."},{"key":"B7","doi-asserted-by":"publisher","first-page":"e514","DOI":"10.1097\/MD.0000000000000514","article-title":"Ex vivo liver resection followed by autotransplantation to a patient with advanced alveolar echinococcosis with a replacement of the retrohepatic inferior vena cava using autogenous vein grafting: a case report and literature review","volume":"94","author":"Jianyong","year":"2015","journal-title":"Medicine."},{"key":"B8","doi-asserted-by":"publisher","first-page":"1668","DOI":"10.1111\/ajt.14621","article-title":"Novel techniques and preliminary results of ex vivo liver resection and autotransplantation for end-stage hepatic alveolar echinococcosis: a study of 31 cases","volume":"18","author":"Yang","year":"2018","journal-title":"Am J Transplant."},{"key":"B9","doi-asserted-by":"publisher","first-page":"889","DOI":"10.1016\/j.surg.2018.11.007","article-title":"Vascular infiltration-based surgical planning in treating end-stage hepatic alveolar echinococcosis with ex vivo liver resection and autotransplantation","volume":"165","author":"Qiu","year":"2019","journal-title":"Surgery."},{"key":"B10","doi-asserted-by":"publisher","first-page":"S283","DOI":"10.1016\/j.parint.2005.11.041","article-title":"WHO classification of alveolar echinococcosis: principles and application","volume":"55","author":"Kern","year":"2006","journal-title":"Parasitol Int."},{"key":"B11","doi-asserted-by":"publisher","first-page":"1457","DOI":"10.1007\/s11605-015-2842-z","article-title":"Application of a three-dimensional reconstruction technique in liver autotransplantation for end-stage hepatic alveolar echinococcosis","volume":"19","author":"He","year":"2015","journal-title":"J Gastrointest Surg."},{"key":"B12","doi-asserted-by":"publisher","first-page":"1317","DOI":"10.1002\/hep.1840210515","article-title":"Calculation of child and adult standard liver volume for liver transplantation","volume":"21","author":"Urata","year":"1995","journal-title":"Hepatology."},{"key":"B13","doi-asserted-by":"publisher","first-page":"1229","DOI":"10.1111\/j.1600-6143.2011.03909.x","article-title":"Accurate estimation of living donor right hemi-liver volume from portal vein diameter measurement and standard liver volume calculation","volume":"12","author":"Tongyoo","year":"2012","journal-title":"Amer J Transplant."},{"key":"B14","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1097\/SLA.0b013e3181b13ca2","article-title":"The Clavien-Dindo classification of surgical complications: five-year experience","volume":"250","author":"Clavien","year":"2009","journal-title":"Ann Surg."},{"key":"B15","doi-asserted-by":"publisher","first-page":"757","DOI":"10.1097\/SLA.0000000000000948","article-title":"The comprehensive complication index: a novel and more sensitive endpoint for assessing outcome and reducing sample size in randomized controlled trials","volume":"260","author":"Slankamenac","year":"2014","journal-title":"Ann Surg."},{"key":"B16","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1007\/s10729-005-5217-2","article-title":"A method for detecting runs of good and bad clinical outcomes on variable life-adjusted display (VLAD) charts","volume":"8","author":"Sherlaw-Johnson","year":"2005","journal-title":"Health Care Manag Sci."},{"key":"B17","doi-asserted-by":"publisher","first-page":"881","DOI":"10.1016\/S1473-3099(14)70727-3","article-title":"China's sustained drive to eliminate neglected tropical diseases","volume":"14","author":"Yang","year":"2014","journal-title":"Lancet Infectious Dis."},{"key":"B18","doi-asserted-by":"publisher","first-page":"315","DOI":"10.1016\/bs.apar.2016.11.001","article-title":"Global distribution of alveolar and cystic echinococcosis","volume":"95","author":"Deplazes","year":"2017","journal-title":"Adv Parasitol."},{"key":"B19","doi-asserted-by":"publisher","first-page":"327","DOI":"10.1097\/00042737-200012030-00011","article-title":"A twenty-year history of alveolar echinococcosis: analysis of a series of 117 patients from eastern France","volume":"12","author":"Bresson-Hadni","year":"2000","journal-title":"Eur J Gastroenterol Hepatol"},{"key":"B20","doi-asserted-by":"publisher","first-page":"351","DOI":"10.1007\/BF02934492","article-title":"Contribution of mass screening system to resectability of hepatic lesions involving Echinococcus multilocularis","volume":"32","author":"Sato","year":"1997","journal-title":"J Gastroenterol."},{"key":"B21","doi-asserted-by":"publisher","first-page":"1708","DOI":"10.1016\/j.transproceed.2016.01.087","article-title":"Liver transplantation for incurable alveolar echinococcosis: an analysis of patients hospitalized in department of tropical and parasitic diseases in Gdynia","volume":"48","author":"Sulima","year":"2016","journal-title":"Transplant Proc."},{"key":"B22","doi-asserted-by":"publisher","first-page":"1096","DOI":"10.1002\/lt.24195","article-title":"Liver transplantation for alveolar echinococcosis in an endemic region","volume":"21","author":"Aydinli","year":"2015","journal-title":"Liver Transpl."},{"key":"B23","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1016\/j.vetpar.2015.07.027","article-title":"Echinococcus multilocularis: epidemiology, surveillance and state-of-the-art diagnostics from a veterinary public health perspective","volume":"213","author":"Conraths","year":"2015","journal-title":"Vet Parasitol."},{"key":"B24","doi-asserted-by":"publisher","first-page":"1037","DOI":"10.1016\/j.jhep.2018.07.006","article-title":"Ex vivo liver resection and autotransplantation as alternative to allotransplantation for end-stage hepatic alveolar echinococcosis","volume":"69","author":"Aji","year":"2018","journal-title":"J Hepatol"},{"key":"B25","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1016\/j.ijscr.2020.03.023","article-title":"In situ reconstruction of vascular inflow\/outflow to left lateral liver section, ex-vivo liver resection and autologous liver transplantation of remaining liver remnant for hepatic alveolar echinococcosis","volume":"69","author":"Zhang","year":"2020","journal-title":"Int J Surg Case Rep."},{"key":"B26","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1007\/s004230050262","article-title":"Ex-vivo resection techniques in tissue-preserving surgery for liver malignancies","volume":"385","author":"Raab","year":"2000","journal-title":"Langenbecks Arch Surg."},{"key":"B27","doi-asserted-by":"publisher","first-page":"2803","DOI":"10.3760\/cma.j.issn.0366-6999.2011.18.001","article-title":"Auto-versus allo-transplantation of the liver for end-stage alveolar echinococcosis?","volume":"124","author":"Mantion","year":"2011","journal-title":"Chin Med J (Engl)"},{"key":"B28","doi-asserted-by":"publisher","first-page":"1030","DOI":"10.1016\/j.jhep.2018.12.011","article-title":"Is ex vivo liver resection and autotransplantation a valid alternative treatment for end-stage hepatic alveolar echinococcosis in Europe?","volume":"70","author":"Beldi","year":"2019","journal-title":"J Hepatol."},{"key":"B29","doi-asserted-by":"publisher","first-page":"106145","DOI":"10.1016\/j.ijscr.2021.106145","article-title":"Comment on a new treatment strategy for end-stage hepatic alveolar echinococcosis: IVC resection without reconstruction","volume":"84","author":"Akbulut","year":"2021","journal-title":"Int J Surg Case Rep"},{"key":"B30","doi-asserted-by":"publisher","first-page":"1408","DOI":"10.1017\/S0031182020001390","article-title":"Comment on surgical approaches for definitive treatment of hepatic alveolar echinococcosis: results of a survey in 178 patients","author":"Akbulut","year":"","journal-title":"Parasitology"},{"key":"B31","doi-asserted-by":"publisher","first-page":"1540","DOI":"10.1007\/s11605-019-04342-6","article-title":"Usability of inferior vena cava interposition graft during living donor liver transplantation: is this approach always necessary?","volume":"24","author":"Gonultas","year":"2020","journal-title":"J Gastrointest Surg"},{"key":"B32","doi-asserted-by":"publisher","first-page":"1400","DOI":"10.1002\/sim.8847","article-title":"An overview and critique of the use of cumulative sum methods with surgical learning curve data","volume":"40","author":"Woodall","year":"2021","journal-title":"Statist Med."},{"key":"B33","first-page":"91","article-title":"Aborted donor hepatectomy in living donor liver transplantation: lessons learned","volume":"58","author":"Kutluturk","year":"2020","journal-title":"S Afr J Surg"},{"key":"B34","doi-asserted-by":"publisher","first-page":"872","DOI":"10.1111\/tri.13859","article-title":"Safe use of right lobe living donor livers with moderate steatosis in adult-to-adult living donor liver transplantation: a retrospective study","volume":"34","author":"Yoon","year":"2021","journal-title":"Transpl Int"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2021.753968\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,1]],"date-time":"2021-12-01T15:51:44Z","timestamp":1638373904000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2021.753968\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,30]]},"references-count":34,"alternative-id":["10.3389\/fsurg.2021.753968"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2021.753968","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11,30]]},"article-number":"753968"}}