Introduction Despite advances in surgical and anaesthetic techniques made over the last 2 decades, right hepatic trisectionectomy (RHT) is still a challenging procedure associated with higher rates of morbidity and mortality. Some patients may even require further extension of the resection to include part of segments II/III to achieve clearance (extended right hepatic trisectionectomy, ERHT). Aim of the study was to assess and compare the early and long-term outcomes of RHT and ERHT in our Unit.
Methods From January 1993 to December 2010, 252 RHT and 80 ERHT were performed (n=332). Resection for colorectal liver metastases (CRLM), HCC, cholangiocarcinoma and other were 127, 43, 25 and 57 for RHT and 60, 3, 2, 15 for ERHT respectively. Mean age was 58.3 vs 57.9 and 57.1% vs 55% were males (RHT vs ERHT, p=NS). There were 61 caudatectomy in the RHT group and 15 in the ERHT (p=0.36, NS); vascular resection (IVC or PV) was performed in 61 and 10 cases (p=0.18, NS), biliary reconstruction was performed in 75 and 7 cases (p=0.01) and total vascular exclusion was necessary in 26 and 6 cases respectively (p=NS). The amount of functional hepatic remnant was based on intra-operative judgement.
Results There were 23 in-hospital deaths (6.9%, RHT: 19, ERHT: 4; p=NS). Overall morbidity was 44% (RHT) and 47.5% (ERHT). Bile leak (17 vs 3), haemorrhage (14 vs 4), sepsis (33 vs 9), cardio-vascular events (12 vs 1) and renal failure (12 vs 3) did not differ among the two groups (RHT vs ERHT; p=NS). There were 42 (12.6%) post-hepatectomy liver failure (according to “50:50 criteria”): 23 in the RHT group and 19 in the ERHT group respectively (p=0.001). Mean hospital stay was 15.8 vs 17.1 days (RHT vs ERHT, p=NS). In the CRLM cohort, 1, 5 and 10 year survival was 78%, 47% and 39% vs 79%, 47% and 37% (RHT vs ERHT, p=0.93, NS). Median survival was 49 and 43.9 months respectively (p=NS) and median follow-up was 59.7 and 56.5 months (RHT vs ERHT).
Conclusion RHT and ERHT are a major undertaking with significant morbidity and mortality but represent the only chance of cure in selected patients. Liver failure is higher in the ERHT group but does not translate in increased mortality. Long-term survival in CRLM is achievable and does not differ among the two groups. Extensive liver resections even beyond conventional boundaries should not be considered an absolute contraindication to surgery.
Competing interests None declared.