Surgeons can safely resect complex liver tumors using a novel two-stage approach that minimizes ischemic injury.

• Combining total vascular exclusion with veno-venous ECMO and hypothermic perfusion led to negative margins in a patient with unresectable intrahepatic cholangiocarcinoma.
• Operative time was 4 hours and 3 minutes, with 72 minutes of hypothermic perfusion and 130 minutes of ECMO support, resulting in uneventful recovery.

Consider this approach for patients with centrally located liver tumors previously deemed unresectable.

• The method may reduce complications and improve outcomes in high-risk surgical cases.