Left hepatic trisectionectomy for hepatobiliary malignancy: results and an appraisal of its current role

Abstract

Objective: To analyze results of 70 patients undergoing left hepatic trisectionectomy and to clarify its current role.

Summary background data: Left hepatic trisectionectomy remains a complicated hepatectomy, and few reports have described the long-term results of the procedure.

Methods: Short-term and long-term outcomes of 70 consecutive patients who underwent left hepatic trisectionectomy from January 1993 to February 2004 were analyzed.

Results: Of the 70 patients, 36 had colorectal liver metastasis, 24 had cholangiocarcinoma, 4 had hepatocellular carcinoma, and the remaining 6 had other tumors. Overall morbidity, 30-day and 90-day mortality rates were 46%, 7%, and 9%, respectively. Multivariate analysis disclosed that preoperative jaundice and intraoperative blood transfusion were positive independent predictors for postoperative morbidity; however, there were no independent predictors for postoperative mortality. Postoperative morbidity (87% versus 35%, P < 0.001) and mortality (20% versus 5%, P = 0.108) were observed more frequently in patients with preoperative obstructive jaundice than in those without jaundice. Each survival according to tumor type was acceptable compared with reported survivals. Survival for patients with colorectal liver metastasis undergoing left hepatic trisectionectomy with concomitant partial resection of the remnant liver was similar to those without this concomitant procedure. This concomitant procedure was not associated with postoperative morbidity and mortality.

Conclusions: Left hepatic trisectionectomy remains a challenging procedure. Preoperative obstructive jaundice considerably increases perioperative risk. Concomitant partial resection of the remaining liver appears to be safe and offers the potential for cure in patients with colorectal metastasis affecting all liver segments.

FIGURE 1. Magnetic resonance imaging of a 58-year-old man with multiple liver metastases from a sigmoid colon cancer. Tumors are demonstrated in almost all hepatic segments. This patient underwent left hepatic trisectionectomy and partial resections of the remnant liver, and is alive without recurrence 10 months after the surgery. The number in the figure indicates the segment where the tumor exists.

FIGURE 2. A, Survival curves according to tumor type. These survivals include postoperative mortality. HCC, hepatocellular carcinoma; PHCC, perihilar cholangiocarcinoma; ICC, intrahepatic cholangiocarcinoma; LMCR, liver metastasis from colorectal cancer. B, Survival curves of patients with liver metastasis from colorectal cancer. These survivals include postoperative mortality. There is no significant difference between survivals for patients who underwent left hepatic trisectionectomy with and without partial resection of the remnant liver. with S6,7, left hepatic trisectionectomy with partial resection of the remnant liver; without S6,7, left hepatic trisectionectomy without partial resection of the remnant liver. C, Survival curves of patients who underwent hepatic trisectionectomy for perihilar cholangiocarcinoma between January 1993 and February 2004 in our center. LT, left hepatic trisectionectomy; RT, right hepatic trisectionectomy.