Elra, or ex vivo liver resection and autotransplantation, offers a promising solution for patients with hepatic alveolar echinococcosis facing cavernous transformation of the portal vein.

• No intraoperative mortality in both treatment groups; 90-day mortality was 16.7%.
• Long-term survival for CTPV patients undergoing elra was 72.9%, compared to 29.6% for those treated conservatively.

The data supports elra as a safe option that significantly enhances long-term survival, even with CTPV present.

• Longest operative times and more blood transfusions were needed for the CTPV group; pleural effusion was the most common complication.