Left hepatic trisectionectomy for hepatobiliary malignancies: Its' role and outcomes. A retrospective cohort study.

Marcos Kostalas,Nariman D Karanjia,Nadeen Low,Rajiv Lahiri,Rajesh Kumar,Angela T Riga,Adam E Frampton,Ee Jun Ban,Tim R Worthington

doi:10.1016/j.amsu.2019.11.016

Abstract

BackgroundLeft hepatic trisectionectomy (LHT) is a complex hepatic resection; its’ role and outcomes in hepatobiliary malignancies remains unclear.Materials and methodsAll patients undergoing LHT at the tertiary HPB referral unit at RSCH, Guildford, UK from September 1996 to October 2015 were included. Data were collected from a prospectively maintained database.ResultsTwenty-eight patients underwent LHT. The M:F ratio was 1.8:1. Median age was 60 years (range 43–76 years). Diagnoses included colorectal liver metastases (CRLM; n = 20); cholangiocarcinoma (CCA; n = 4); and other (neuroendocrine tumour metastases (NET; n = 3) and breast metastases (n = 1)). Median duration of surgery was 270 min (range 210–585 min). Median blood loss was 750 ml (300–2400 ml) with a perioperative transfusion rate of 21% (n = 6/28). The rate of all post-operative complications was 21% for all patients, and given the extensive resection performed four patients (14%) developed varying degrees of hepatic insufficiency. One patient with cholangiocarcinoma developed severe hepatic insufficiency, which was fatal within 90 days of surgery. 1 and 3-year survivals were 92% and 68% respectively.ConclusionThis study supports LHT in patients with significant tumour burden. Despite extensive resection, our favourable morbidity and mortality rates show this is a safe and beneficial procedure for patients with all hepatobiliary malignancies. Given the nature of resection the incidence of post-operative hepatic insufficiency is higher than less extensive hepatic resections.

Highlights

Left hepatic trisectionectomy (LHT) was first described in 1982 by Starzl and colleagues [1] and later by Blumgart in 1993 [2]
The International Hepato-Pancreato-Biliary Association (IHPBA) consensus statement [3] defines the resection as excision of Couinaud segments II, III, IV, V and VIII, with or without segment I
The aim of this study was to assess the short and long-term outcomes of LHT for patients with cholangiocarcinoma (CCA) or large volume liver metastases at our institution, and to identify any factors associated with morbidity and mortality

Summary

Introduction

Left hepatic trisectionectomy (LHT) was first described in 1982 by Starzl and colleagues [1] and later by Blumgart in 1993 [2]. The first large series on peri-operative outcomes was published in 1999 4, and found an increased rate of morbidity and mortality, 53% and 8% respectively, when compared with other less extensive hepatic resections. It highlighted the utility of LHT in lesions that were considered to previously be unresectable [4]. The rate of all post-operative complications was 21% for all patients, and given the extensive resection performed four patients (14%) developed varying degrees of hepatic insufficiency. Our favourable morbidity and mortality rates show this is a safe and beneficial procedure for patients with all hepatobiliary malignancies. Given the nature of resection the incidence of post-operative hepatic insufficiency is higher than less extensive hepatic resections

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