Liver Cancer Surgery in China: In Vivo Cold Perfusion Rescues Advanced Patient

For patients searching for advanced liver cancer surgery in China, the question is often whether any hospital will accept a case deemed inoperable elsewhere. A recent report from Sichuan Provincial People’s Hospital shows how a specialized technique called in vivo cold perfusion is giving some of these patients a surgical option. A 29-year-old woman with late-stage intrahepatic cholangiocarcinoma, previously told her tumor could not be removed, traveled alone from Zhejiang to Chengdu and successfully underwent resection.

In Vivo Cold Perfusion: A Second Chance for ‘Inoperable’ Liver Tumors

Intrahepatic cholangiocarcinoma is the second most common primary liver malignancy, known for its aggressive nature and poor prognosis. The patient, identified as Ms. Chen, was diagnosed in July 2025 with a tumor measuring 10.5 cm. Over nine months, she endured 11 rounds of chemotherapy, which shrank the mass to 6.9 cm. However, the tumor still invaded the left and middle hepatic veins and the left branch of the portal vein, making conventional radical resection impossible according to multiple prior consultations.

Upon admission to Sichuan Provincial People’s Hospital, the team led by Professor Zhang Yu conducted a detailed evaluation. They designed an individualized surgical plan to address the vascular invasion. The procedure combined a left hemihepatectomy with inferior vena cava reconstruction and hepaticojejunostomy, all performed under in vivo cold perfusion. During the operation, the team precisely dissected and temporarily blocked the liver’s blood vessels, then perfused a 4°C organ preservation solution through the portal vein. This rapidly lowered the liver’s core temperature, effectively putting it into a protective, low-metabolism state. This “hibernation” created a critical time window for the surgeons to meticulously remove the tumor and reconstruct the involved vessels and bile ducts.

How the Technique Works and Why It Matters

In vivo cold perfusion is not entirely new; early explorations abroad date back to around 2000. However, those early protocols were extremely complex, required demanding equipment, and carried a surgical mortality rate as high as 30%, preventing widespread adoption. The Sichuan team spent four years refining a simplified clinical approach. Crucially, their method avoids removing the liver from the body (ex vivo surgery) and does not require veno-venous bypass, a procedure that itself carries risks of bleeding, thrombosis, and infection.

“The core of in vivo cold perfusion technology is creating a controllable, safe, and prolonged period of liver ischemia,” explained Professor Zhang. “It’s like putting the liver into hibernation, providing a crucial time window for complex vascular resection and reconstruction, while avoiding the massive trauma and risks of removing the entire liver.” Compared to traditional ex vivo surgery, the streamlined process is easier to adopt and results in fewer complications for patients. The team has now used this technique to complete resections for over 130 patients with complex liver tumors who had been told surgery was impossible, making it the hospital with the largest such case series in China.

Standardizing Complexity: The Five-Type Classification System

Moving beyond individual expertise, the team has systematized their experience. Based on over a hundred successful cases, they published an innovative “five-type classification” in international journals like Annals of Surgery. This system categorizes surgeries into five types based on the pattern and extent of tumor invasion into intrahepatic blood vessels. For each type, it standardizes the vascular management strategy, perfusion route, and reconstruction priority. Previously, tackling a large tumor invading multiple major vessels relied heavily on a surgeon’s personal experience. This classification acts as a navigational guide, telling the team exactly which vessels must be repaired and whether the surgery can be completed entirely in vivo. The work has also been recognized with a key project grant from the National Natural Science Foundation of China. The hospital has now expanded the application of in vivo cold perfusion beyond liver surgery to radical resections for complex tumors of the bile duct, pancreas, and retroperitoneum.

Ms. Chen’s recovery exceeded expectations. She was transferred to a general ward on the second day after surgery and began eating by the fifth day, with stable vital signs and gradual recovery of liver function. “I think such good technology and such good doctors should be known to more people, especially late-stage liver cancer patients like me, so they know there is still hope to live,” she said during an interview before discharge.

Source: 四川省人民医院