Morbidity Analysis of Left Hepatic Trisectionectomy for Hepatobiliary Disease and Live Donor

Abstract

Introduction: Despite remarkable advances in surgical techniques and perioperative management, left hepatic trisectionectomy (LHT) remains a challenging procedure with a somewhat higher postoperative morbidity compared with less-extensive resections. The aims of this study were to analyze the short- and long-term outcomes of LHT and to identify factors associated with postoperative morbidity of this technically demanding surgical procedure. Method: The medical records of 52 patients who underwent LHT between June 2005 and October 2019 at a single institution were retrospectively reviewed. Results: Hepatocellular carcinoma was the most common indication for surgery (n=21), followed by hilar cholangiocarcinoma (n=14), intrahepatic cholangiocarcinoma (n=9), and other pathologies (including colorectal liver metastasis, hepatolithiasis, gallbladder cancer, living donor, hemangioma, and multilocular biliary cyst; n=8). The rates of postoperative morbidities of Clavian-Dindo grade 3 or higher and 90-day mortality were 38.5% and 1.9%, respectively. The overall 1-,3-,and 5-year survival rates were 80.8%, 62.6%, and 45.5%, respectively. Preoperative portal vein embolization (p=0.017), an American Society of Anesthesiologists fitness grade > II (p=0.008), operation time (p=0.014), extent of surgery by concomitant extrahepatic bile duct resection (p=0.043) and lymphadenectomy (p=0.005), and the number of tumors (p=0.012) were independent predictors of postoperative morbidity on multivariable analysis. Conclusions: The success of LHT is dependent on a reliable preoperative evaluation of liver function and the anatomic features of right posterior portal vein variants and hepatic veins toward the posterior sector, active and appropriate preoperative management for obstructive cholangitis and compensatory hypertrophy of the future remnant posterior sector, and the experience of the surgeon.