Faculty Collaboration Database

Right hepatic trisectionectomy for hepatobiliary diseases: results and an appraisal of its current role. Ann Surg 2007 Dec;246(6):1065-74

Date

11/29/2007

Pubmed ID

18043112

DOI

10.1097/SLA.0b013e3181492795

Scopus ID

2-s2.0-36549057031 (requires institutional sign-in at Scopus site)   39 Citations

Abstract

OBJECTIVE: To assess the results of 275 patients undergoing right hepatic trisectionectomy and to clarify its current role.

SUMMARY BACKGROUND DATA: Right hepatic trisectionectomy is considered one of the most extensive liver resections, and few reports have described the long-term results of the procedure.

METHODS: Short- and long-term outcomes of 275 consecutive patients who underwent right hepatic trisectionectomy from January 1993 to January 2006 were analyzed.

RESULTS: Of the 275 patients, 160 had colorectal metastases, 49 had biliary tract cancers, 20 had hepatocellular carcinomas, 20 had other metastatic tumors, and 12 had benign diseases. Fourteen of the 275 patients underwent right hepatic trisectionectomy as part of auxiliary liver transplantation for acute liver failure and were excluded. Concomitant procedures were carried out in 192 patients: caudate lobectomy in 45 patients, resection of tumors from the liver remnant in 57 patients, resection of the extrahepatic biliary tree in 45 patients, and lymphadenectomy in 45 patients. One-, 3-, 5-, and 10-year survivals were 74%, 54%, 43%, and 36%, respectively. Overall hospital morbidity and 30-day and in-hospital mortalities were 41%, 7%, and 8%, respectively. Survivals for individual tumor types were acceptable, with 5-year survivals for colorectal metastasis and cholangiocarcinoma being 38% and 32%, respectively. Multivariate analysis disclosed the amount of intraoperative blood transfusion to be the sole independent predictor for the development of hospital morbidity. Age over 70 years, preoperative bilirubin levels, and the development of postoperative renal failure were found to be independent predictors of long-term survival.

CONCLUSION: Right hepatic trisectionectomy remains a challenging procedure. The outcome is not influenced by additional concomitant resection of tumors from the planned liver remnant. Caution must be taken when considering patients older than 70 years for such resections.

Author List

Halazun KJ, Al-Mukhtar A, Aldouri A, Malik HZ, Attia MS, Prasad KR, Toogood GJ, Lodge JP

Author

Kondragunta Rajendra Prasad MBBS Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Aged, 80 and over
Female
Follow-Up Studies
Hepatectomy
Humans
Liver Neoplasms
Magnetic Resonance Imaging
Male
Middle Aged
Retrospective Studies
Survival Rate
Time Factors
Treatment Outcome
United Kingdom