Patrícia Viana, Michael Irby, Narendra Battula, Maheshwaran Pitchaimuthu, Barish H. Edil, Ajay Jain, Claire Goumard, Olivier Scatton, Paulo N. Martins
OBJECTIVE: To review the role of machine perfusion in complex in situ and ex situ liver resections and its potential to improve perioperative and oncologic outcomes. SUMMARY BACKGROUND DATA: Complex liver resections requiring prolonged vascular exclusion are limited by ischemia reperfusion injury and postoperative liver failure. Machine perfusion, established in liver transplantation to enhance organ preservation and functional assessment, is increasingly applied to advanced hepatobiliary surgery. METHODS: A narrative review of experimental and clinical studies evaluating hypothermic and normothermic machine perfusion in in situ and ex situ liver surgery was performed. RESULTS: Current evidence indicates that machine perfusion is feasible and safe in complex liver resections, allowing prolonged vascular control while preserving liver function. Early clinical reports demonstrate improved postoperative recovery and successful oncologic resections, with emerging transplant data suggesting a potential reduction in tumor recurrence. CONCLUSIONS: Machine perfusion may expand the boundaries of complex liver surgery by mitigating ischemia reperfusion injury and enabling otherwise unresectable procedures. Prospective studies are required to define optimal perfusion strategies and long term oncologic outcomes.