title: Left hepatic trisectionectomy for hepatobiliary malignancies.
abstract: BACKGROUND
  Left hepatic trisectionectomy is the most extended hepatic resection. To date, few data are available on longterm outcomes after this operation.
  
  
  METHODS
  Between June 1998 and July 2004, a total of 52 patients underwent left trisectionectomy for primary or secondary hepatobiliary tumors at our institution. Data were analyzed with regard to patient characteristics, intraoperative details, pathologic findings, perioperative morbidity and mortality, and outcomes as determined by survival.
  
  
  RESULTS
  Left trisectionectomy was combined with caudate lobectomy and hilar lymph node dissection in 29 and 35 patients, respectively. In addition, 43 procedures were performed in 31 patients: resection of hilar bifurcation (n = 15), bile-duct revision (n = 5), wedge resection of segment VI/VII (n = 10), gastrectomy (n = 1), and resection or reconstruction of hepatic vessels or the inferior vena cava (n = 12). Operative morbidity and mortality were 50% and 11.9%, respectively. By multivariate analysis, additional operative procedures constituted the only positive predictor of postoperative morbidity. One-, 3-, and 5-year survival rates were 65%, 52%, and 33%, respectively. After R0 resection (n = 37), 1-, 3-, and 5-year survival rates were 78%, 68%, and 44% compared with 38%, 15%, and 7% after R1 resection (p = 0.0004). Survival corresponding to the four most frequent tumor types (hepatocellular carcinoma, cholangiocellular carcinoma, hilar cholangiocarcinoma, and colorectal metastases) was comparable with survival data reported in the literature after less-extensive resections.
  
  
  CONCLUSIONS
  Left trisectionectomy provides acceptable survival rates in both locally advanced primary hepatobiliary malignancies and large metastatic liver tumors. Despite major progress in surgical technique and perioperative management, left trisectionectomy is still associated with higher operative mortality and morbidity than less-extensive resections. Because selection criteria for this type of procedure are not clearly defined, particular attention should be focused on the oncologic benefits when considering this operation.
authors.affiliation: Department of General Surgery, Visceral Surgery and Transplantation, University Hospital of Essen, Essen, Germany. hauke.lang@uni-essen.de
authors.forename: Hauke
authors.initials: H
authors.lastname: Lang
authors.forename: Georgios C
authors.initials: GC
authors.lastname: Sotiropoulos
authors.forename: Eirini I
authors.initials: EI
authors.lastname: Brokalaki
authors.forename: Arnold
authors.initials: A
authors.lastname: Radtke
authors.forename: Andrea
authors.initials: A
authors.lastname: Frilling
authors.forename: Ernesto P
authors.initials: EP
authors.lastname: Molmenti
authors.forename: Massimo
authors.initials: M
authors.lastname: Malagó
authors.forename: Christoph E
authors.initials: CE
authors.lastname: Broelsch
mesh_terms: D000328:Adult; D000368:Aged; D001661:Biliary Tract Neoplasms / Q000473:pathology / Q000601:surgery*; D006528:Carcinoma, Hepatocellular / Q000601:surgery; D018281:Cholangiocarcinoma / Q000601:surgery; D015179:Colorectal Neoplasms / Q000556:secondary; D005260:Female; D005706:Gallbladder Neoplasms / Q000473:pathology / Q000601:surgery; D006498:Hepatectomy / Q000379:methods* / Q000401:mortality; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D015996:Survival Rate; D016896:Treatment Outcome