Skip to main content

Advertisement

SpringerLink
Log in

Liver trisectionectomies for primary and secondary liver cancer in the modern era: results of a single tertiary center

  • Original Article
  • Published:
Updates in Surgery Aims and scope Submit manuscript

Abstract

Recent advances in patient selection and surgical technique have resulted in low mortality and morbidity rates after liver resections. The aim of this study was to evaluate the operative risks of liver trisectionectomies in comparison with major resections. The data prospectively collected of patients who underwent trisectionectomies (TR Group, n = 54) and major hepatectomies (MH Group, n = 175) without biliary reconstruction were compared. Besides, the early results of patients who underwent right trisectionectomies (RTR Group, n = 36) and left trisectionectomies (LTR Group, n = 18) were compared. There was no significant difference in patient characteristics of MH and TR groups excluded for a high portal vein embolization (PVE) in TR group. Mortality (1% in MH group and 3.7% in TR group, p = 0.206) and overall morbidity rates (39% in MH group and 48% in TR group, p = 0.225) were similar between two groups. A higher proportion of patients in TR group developed liver failure (p = 0.024) and required blood transfusion (30 vs. 11%, p < 0.001). The median hospital stay after trisectionectomies was higher in TR group than MH group (p = 0.053). There was no significant difference in patient characteristics of LTR and RTR groups excluded for lymphadenectomy which was higher in LTR group (p = 0.008) and PVE rate higher in RTR group (p = 0.01). The overall morbidity (44 vs. 55%) and mortality (2.7 vs. 5.5%) were comparable between two groups. A higher proportion of patients in RTR group required blood transfusion (39 vs. 11%, p = 0.032). At multivariate analysis, age was the only positive predictor for morbidity after trisectionectomies (p = 0.010). Trisectionectomies can be performed safely. Left trisectionectomies are as safe as right trisectionectomies. The accurate preoperative selection is necessary to reduce operative risks.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Povoski SP, Fong Y, Blumgart LH (1999) Extended left hepatectomy. World J Surg 23:1289–1293

    Article  CAS  PubMed  Google Scholar 

  2. Nishio H, Hidalgo E, Hamady ZZR et al (2005) Left hepatic for hepatobiliary malignancy—results and an appraisal of its current role. Ann Surg 242:267–275

    Article  PubMed  Google Scholar 

  3. Melendez J, Ferri E, Zwillman M et al (2001) Extended hepatic resection: a 6-year retrospective study of risk factors for perioperative mortality. J Am Coll Surg 192:47–53

    Article  CAS  PubMed  Google Scholar 

  4. Wei AC, Poon RTP, Fan ST et al (2003) Risk factors for perioperative morbidity and mortality after extended hepatectomy for hepatocellular carcinoma. Br J Surg 90:33–41

    Article  CAS  PubMed  Google Scholar 

  5. Iwatsuki S, Starzl TE (1988) Personal experience with 411 hepatic resections. Ann Surg 208:421–434

    Article  CAS  PubMed  Google Scholar 

  6. Jarnagin WR, Gonen M, Fong Y et al (2002) Improvement in perioperative outcome after hepatic resection: analysis of 1,803 consecutive cases over the past decade. Ann Surg 236:397–406

    Article  PubMed  Google Scholar 

  7. Belghiti J, Hiramatsu K, Benoist S et al (2000) Seven hundred forty-seven hepatectomies in the 1990s: an update to evaluate the actual risk of liver resection. J Am Coll Surg 191:38–46

    Article  CAS  PubMed  Google Scholar 

  8. Fan ST, Lo CM, Liu CL et al (1999) Hepatectomy for hepatocellular carcinoma: toward zero hospital deaths. Ann Surg 229:322–330

    Article  CAS  PubMed  Google Scholar 

  9. Poon RT, Fan ST, Lo CM et al (2004) Improving perioperative outcome expands the role of hepatectomy in management of benign and malignant hepatobiliary diseases: analysis of 1222 consecutive patients from a prospective database. Ann Surg 240:698–708; discussion 708–710

    PubMed  Google Scholar 

  10. Kamiyama T, Nakanishi K, Yokoo H et al (2010) Perioperative management of hepatic resection toward zero mortality and morbidity: analysis of 793 consecutive cases in a single institution. Am Coll Surg 211:443–449

    Article  Google Scholar 

  11. Kanai M, Nimura Y, Kamiya J et al (1996) Preoperative intrahepatic segmental cholangitis in patients with advanced carcinoma involving the hepatic hilus. Surgery 119:498–504

    Article  CAS  PubMed  Google Scholar 

  12. Ferrero A, Viganò L, Polastri R et al (2007) Postoperative liver dysfunction and future remnant liver: where is the limit? Results of a prospective study. World J Surg 31:1643–1651

    Article  PubMed  Google Scholar 

  13. Terminology Committee of the International Hepato-Pancreato-Biliary Association (2000) The Brisbane 2000 terminology of liver anatomy and resection. HPB 2:333–339

  14. Nagino M, Nishio H, Ebata Y et al (2007) Intrahepatic cholangiojejunostomy following hepatobiliary resection. Br J Surg 94:70–77

    Article  CAS  PubMed  Google Scholar 

  15. Imamura H, Sano K, Sugawara Y et al (2005) Assessment of hepatic reserve for indication of hepatic resection: decision tree incorporating indocyanine green test. J Hepatobiliary Pancreat Surg 12:16–22

    Article  PubMed  Google Scholar 

  16. Belghiti J, Guevara OA, Noun R et al (2001) Liver hanging maneuver: a safe approach to right hepatectomy without liver mobilization. J Am Coll Surg 193:109–111

    Article  CAS  PubMed  Google Scholar 

  17. Capussotti L, Ferrero A, Viganò L et al (2006) Bile leakage and liver resection: where is the risk? Arch Surg 141:690–694

    Article  PubMed  Google Scholar 

  18. Imamura H, Seyama Y, Kokudo N et al (2003) One thousand fifty-six hepatectomies without mortality in 8 years. Arch Surg 138:1198–1206

    Article  PubMed  Google Scholar 

  19. American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis (1992) Crit Care Med 20:864–874

    Google Scholar 

  20. Dindo D, Clavien PA (2008) What is a surgical complication? World J Surg 32:939–941

    Article  PubMed  Google Scholar 

  21. Poon RT, Fan ST, Lo CM et al (2002) Extended hepatic resection for hepatocellular carcinoma in patients with cirrhosis: is it justified? Ann Surg 236:602–611

    Article  PubMed  Google Scholar 

  22. Neuhaus P, Jonas S, Bechstein WO et al (1999) Extended resection for hilar cholangiocarcinoma. Ann Surg 230:808–818

    Article  CAS  PubMed  Google Scholar 

  23. Rui JA, Wang SB, Chen SG et al (2003) Right trisectionectomy for primary liver cancer. World J Gastroenterol 9:706–709

    PubMed  Google Scholar 

  24. Lang H, Sotiropoulos GC, Frühauf NR et al (2005) Extended hepatectomy for intrahepatic cholangiocellular carcinoma (ICC): when is it worthwhile? Single center experience with 27 resections in 50 patients over a 5-year period. Ann Surg 241:134–143

    PubMed  Google Scholar 

  25. Al-Hadeedi S, Choi TK, Wong J (1990) Extended hepatectomy for hepatocellular carcinoma. Br J Surg 77:1247–1250

    Article  CAS  PubMed  Google Scholar 

  26. Fong Y, Fortner J, Sun RL et al (1999) Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer analysis of 1001 consecutive cases. Ann Surg 230:309–318

    Article  CAS  PubMed  Google Scholar 

  27. Coelho JC, Claus CM, Machuca TN et al (2004) Liver resection: 10-year experience from a single institution. Arq Gastroenterol 41:229–233

    PubMed  Google Scholar 

  28. Cockbain AJ, Masudi T, Lodge JP et al (2010) Predictors of blood transfusion requirement in elective liver resection. HPB 12:50–55

    Article  PubMed  Google Scholar 

  29. Uesaka K, Nimura Y, Nagino M (1996) Changes in hepatic lobar function after right portal vein embolization. An appraisal by biliary indocyanine green excretion. Ann Surg 223:77–83

    Article  CAS  PubMed  Google Scholar 

  30. Hirai I, Kimura W, Fuse A et al (2003) Evaluation of preoperative portal embolization for safe hepatectomy, with special reference to assessment of nonembolized lobe function with 99mTc-GSA SPECT scintigraphy. Surgery 133:495–506

    Article  PubMed  Google Scholar 

  31. Vauthey JN, Pawlik TM, Abdalla EK et al (2004) Is extended hepatectomy for hepatobiliary malignancy justified? Ann Surg 239:722–730, discussion 730–732

    Google Scholar 

  32. Lang H, Sotiropoulos GC, Brokalaki EI et al (2006) Left hepatic trisectionectomy for hepatobiliary malignancies. J Am Coll Surg 203:311–321

    Google Scholar 

  33. Halazun KJ, Al-Mukhtar A, Aldouri A et al (2007) Right hepatic trisectionectomy for hepatobiliary diseases: results and an appraisal of its current role. Ann Surg 246:1065–1074

    Google Scholar 

  34. Sastre J, Pallardo FV, Pla R et al (1996) Aging of the liver: age associated mitochondrial damage in intact hepatocytes. Hepatology 24:1199–1205

    Article  CAS  PubMed  Google Scholar 

  35. Muller-Hocker J, Aust D, Rohrbach H et al (1997) Defects of the respiratory chain in the normal human liver and in cirrhosis during aging. Hepatology 26:709–719

    Article  CAS  PubMed  Google Scholar 

  36. Schmucker DL (2005) Age-related changes in liver structure and function: implications for the disease? Exp Gerontol 40:650–659

    Article  CAS  PubMed  Google Scholar 

  37. Capussotti L, Viganò L, Giuliante F et al (2009) Liver dysfunction and sepsis determine operative mortality after liver resection. Br J Surg 96:88–94

    Article  CAS  PubMed  Google Scholar 

  38. Repetto L, Granetto C, Venturino A (1997) Comorbidity and cancer in the aged: the oncologists point of view. Rays 22:17–19

    CAS  PubMed  Google Scholar 

  39. Fagot-Campagna A, Bourdel-Marchasson I, Simon D (2005) Burden of diabetes in an aging population: prevalence, incidence, mortality, characteristics and quality of care. Diabetes Metab 31:5S35–5S52

    Article  PubMed  Google Scholar 

  40. Shirabe K, Shimada M, Gion T et al (1998) Postoperative liver failure after major hepatic resection for hepatocellular carcinoma in the modern era with special reference to the remnant liver volume. J Am Coll Surg 188:304–307

    Article  Google Scholar 

  41. Little SA, Jarnagin WR, DeMatteo RP et al (2002) Diabetes is associated with increased perioperative mortality but equivalent long-term outcome after hepatic resection for colorectal cancer. J Gastrointest Surg 6:88–94

    Article  PubMed  Google Scholar 

  42. Kohli V, Madden J, Clavien PA (1998) Failure of regeneration in the steatotic rat liver: a possible mechanism for poor outcomes after major tissue loss and transplantation. Hepatology 28:525A

    Google Scholar 

  43. Cho SW, Steel J, Tsung A et al (2010) Safety of liver resection in the elderly: how important is age? Ann Surg Oncol. doi:10.1245/s10434-010-1404-6

  44. Adam R, Frilling A, Elias D, Laurent C, Ramos E, Capussotti L, Poston GJ, Wicherts DA, de Haas RJ, LiverMetSurvey Centres (2010) Liver resection of colorectal metastases in elderly patients. Br J Surg 97:366–376

    Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department HPB and Digestive Surgery, Ospedale Mauriziano “Umberto I”, Largo Turati, 620-10128, Turin, Italy

    Nadia Russolillo, Alessandro Ferrero, Luca Viganò, Serena Langella, Marco Amisano & Lorenzo Capussotti

Authors
  1. Nadia Russolillo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alessandro Ferrero
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Luca Viganò
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Serena Langella
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Marco Amisano
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Lorenzo Capussotti
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nadia Russolillo.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Russolillo, N., Ferrero, A., Viganò, L. et al. Liver trisectionectomies for primary and secondary liver cancer in the modern era: results of a single tertiary center. Updates Surg 62, 161–169 (2010). https://doi.org/10.1007/s13304-010-0038-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13304-010-0038-3

Keywords

Search

Navigation