title: Clinical outcomes of left hepatic trisectionectomy for hepatobiliary malignancy.
abstract: BACKGROUND
  Left hepatic trisectionectomy (LHT) is a challenging major anatomical hepatectomy with a high complication rate and a worldwide experience that remains limited. The aim of this study was to describe changes in surgical practice over time, to analyse the outcomes of patients undergoing LHT for hepatobiliary malignancy, and to identify factors associated with morbidity and mortality.
  
  
  METHODS
  A cohort study was undertaken of patients who underwent LHT at a single tertiary hepatobiliary referral centre between January 1993 and March 2013. Univariable and multivariable analysis was used to identify factors associated with short- and long-term outcomes following LHT.
  
  
  RESULTS
  Some 113 patients underwent LHT for colorectal liver metastasis (57), hilar cholangiocarcinoma (22), intrahepatic cholangiocarcinoma (12) and hepatocellular carcinoma (11); 11 patients had various other indications. Overall morbidity and 90-day mortality rates were 46.0 and 9.7 per cent respectively. Overall 1- and 3-year survival rates were 71.3 and 44.4 per cent respectively. Total hepatic vascular exclusion and intraoperative blood transfusion were independent predictors of postoperative morbidity, whereas blood transfusion was the only factor predictive of in-hospital mortality. Time period analysis revealed a decreasing trend in blood transfusion, duration of hospital stay, and postoperative morbidity and mortality in the last 5 years.
  
  
  CONCLUSIONS
  Morbidity, mortality and long-term survival after LHT support its use in selected patients with a significant tumour burden.
authors.affiliation: Hepatobiliary Unit, St James's University Hospital, Beckett Street, Leeds LS9 7TF, UK.
authors.forename: S G
authors.initials: SG
authors.lastname: Farid
authors.affiliation: Hepatobiliary Unit, St James's University Hospital, Beckett Street, Leeds LS9 7TF, UK.
authors.forename: A
authors.initials: A
authors.lastname: White
authors.affiliation: Hepatobiliary Unit, St James's University Hospital, Beckett Street, Leeds LS9 7TF, UK.
authors.forename: N
authors.initials: N
authors.lastname: Khan
authors.affiliation: Hepatobiliary Unit, St James's University Hospital, Beckett Street, Leeds LS9 7TF, UK.
authors.forename: G J
authors.initials: GJ
authors.lastname: Toogood
authors.affiliation: Hepatobiliary Unit, St James's University Hospital, Beckett Street, Leeds LS9 7TF, UK.
authors.forename: K R
authors.initials: KR
authors.lastname: Prasad
authors.affiliation: Hepatobiliary Unit, St James's University Hospital, Beckett Street, Leeds LS9 7TF, UK.
authors.forename: J P A
authors.initials: JP
authors.lastname: Lodge
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000601:surgery*; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D002648:Child; D018281:Cholangiocarcinoma / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000639:trends; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult