摘要Background:Ex vivo liver resection and autotransplantation(ELRA)offers new therapeutic perspectives and possibilities for R0 resection in patients with hepatic alveolar echinococcosis(AE)combined with cavernous transformation of the portal vein(CTPV).Methods:We analyzed 49 hepatic AE patients with CTPV treated at our center from January 2010 to June 2023.We compared the different outcomes with different treatments for the 49 patients:ELRA for 12 and conservative for 9 patients.After propensity score matching,we compared the ELRA treatment outcomes for 12 patients with CTPV and 24 patients without CTPV.Kaplan-Meier analysis was used to compare overall survival,and Cox regression to identify factors influencing postoperative survival.Results:In the ELRA cohort,both CTPV and non-CTPV patients had no intraoperative mortality;90-day mortality rate for both groups was 16.7%(2/12 in CTPV patients and 4/24 in non-CTPV patients).Pleural effusion was the most common postoperative complication.CTPV patients required significantly longer operative time and more intraoperative blood transfusions(P<0.05).However,no significant difference was observed in long-term overall survival between CTPV and non-CTPV patients after ELRA(71.4%vs.74.5%,P>0.05).In the CTPV cohort,patients who underwent ELRA had significantly better long-term survival compared to those who did not receive surgery(72.9%vs.29.6%,P<0.05).Extrahepatic AE dis-ease,rather than CTPV,was identified as an independent risk factor for postoperative survival(P<0.05).Conclusions:ELRA is a safe and effective approach for hepatic AE patients with CTPV,significantly im-proving long-term survival.CTPV itself does not negatively impact postoperative survival,further empha-sizing the benefits of this procedure in this particular population.