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

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

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.

Adult, Aged, Bile Duct Neoplasms/surgery, Bile Ducts, Intrahepatic, Blood Transfusion, Carcinoma, Hepatocellular/surgery, Cholangiocarcinoma/surgery, Colorectal Neoplasms/pathology, Female, Hepatectomy/methods, Humans, Intraoperative Care, Jaundice/complications, Liver Neoplasms/secondary, Male, Middle Aged, Postoperative Complications, Treatment Outcome
0003-4932
267-275
Nishio, Hideki
7761633c-2df1-4d4d-b8a9-65272edd5739
Hidalgo, Ernest
3ee7b7d3-b112-42d7-9d84-912bf5e6f8f3
Hamady, Zaed Z R
545a1c81-276e-4341-a420-aa10aa5d8ca8
Ravindra, Kadiyala V
e9cf299a-00d5-4b94-80b6-c8c1168e0c91
Kotru, Anil
420de6be-9fd4-4603-9e2c-8bb4f3898a6b
Dasgupta, Dowmitra
b4986cdf-aa9f-4418-99ef-1b4917184951
Al-Mukhtar, Ahmed
0ad6bb42-2f62-48e6-a3be-1de7ebc4e127
Prasad, K Rajendra
674781c5-b624-46db-bd4e-3c5b9ba44064
Toogood, Giles J
f2183798-4d71-42fd-bcc9-483f191c066f
Lodge, J Peter A
c97dd104-0cb2-4f05-a008-9b9af01e4820
Nishio, Hideki
7761633c-2df1-4d4d-b8a9-65272edd5739
Hidalgo, Ernest
3ee7b7d3-b112-42d7-9d84-912bf5e6f8f3
Hamady, Zaed Z R
545a1c81-276e-4341-a420-aa10aa5d8ca8
Ravindra, Kadiyala V
e9cf299a-00d5-4b94-80b6-c8c1168e0c91
Kotru, Anil
420de6be-9fd4-4603-9e2c-8bb4f3898a6b
Dasgupta, Dowmitra
b4986cdf-aa9f-4418-99ef-1b4917184951
Al-Mukhtar, Ahmed
0ad6bb42-2f62-48e6-a3be-1de7ebc4e127
Prasad, K Rajendra
674781c5-b624-46db-bd4e-3c5b9ba44064
Toogood, Giles J
f2183798-4d71-42fd-bcc9-483f191c066f
Lodge, J Peter A
c97dd104-0cb2-4f05-a008-9b9af01e4820

Nishio, Hideki, Hidalgo, Ernest, Hamady, Zaed Z R, Ravindra, Kadiyala V, Kotru, Anil, Dasgupta, Dowmitra, Al-Mukhtar, Ahmed, Prasad, K Rajendra, Toogood, Giles J and Lodge, J Peter A (2005) Left hepatic trisectionectomy for hepatobiliary malignancy: results and an appraisal of its current role. Annals of Surgery, 242 (2), 267-275. (doi:10.1097/01.sla.0000171304.70678.11).

Record type: Article

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.

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More information

Published date: 1 August 2005
Keywords: Adult, Aged, Bile Duct Neoplasms/surgery, Bile Ducts, Intrahepatic, Blood Transfusion, Carcinoma, Hepatocellular/surgery, Cholangiocarcinoma/surgery, Colorectal Neoplasms/pathology, Female, Hepatectomy/methods, Humans, Intraoperative Care, Jaundice/complications, Liver Neoplasms/secondary, Male, Middle Aged, Postoperative Complications, Treatment Outcome

Identifiers

Local EPrints ID: 455735
URI: http://eprints.soton.ac.uk/id/eprint/455735
ISSN: 0003-4932
PURE UUID: ce663f8f-779f-46c1-85bc-414030257768
ORCID for Zaed Z R Hamady: ORCID iD orcid.org/0000-0002-4591-5226

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Date deposited: 31 Mar 2022 16:48
Last modified: 17 Mar 2024 04:12

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Contributors

Author: Hideki Nishio
Author: Ernest Hidalgo
Author: Zaed Z R Hamady ORCID iD
Author: Kadiyala V Ravindra
Author: Anil Kotru
Author: Dowmitra Dasgupta
Author: Ahmed Al-Mukhtar
Author: K Rajendra Prasad
Author: Giles J Toogood
Author: J Peter A Lodge

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