Extended left hepatectomy

Extended left hepatectomy (resection of Couinaud segments II, III, IV, V, and VIII of the liver) has only slowly been appreciated as a viable resectional technique for large, strategically placed, left-sided and central hepatic lesions that extend to involve the right anterior sectoral portal pedicular structures. We report on the preoperative, intraoperative, and postoperative findings of 51 patients undergoing extended left hepatectomy at Memorial Sloan-Kettering from 1992 to 1998. Median age was 58 years (range 1-85), with 28 males and 23 females. Altogether 34 patients had metastatic hepatic malignancies, 14 had primary hepatic malignancies, and 3 had benign hepatic lesions. Median postoperative length of stay was 10 days (range 6-52). Postoperative morbidity and mortality were 53% and 8%, respectively. Multivariate analysis of multiple preoperative variables disclosed that only the largest hepatic lesion of >8 cm (p = 0.033) was an independent predictor of a positive microscopic margin or tumor within one high power field. No preoperative, intraoperative, or postoperative variables were independent predictors of postoperative morbidity or mortality. Utilization of extended left hepatectomy allows resection of critically positioned hepatic lesions previously thought unresectable. It can be performed relatively safely, although it is not without somewhat increased postoperative morbidity and mortality compared to lesser anatomic hepatic resections. Patient selection, as dictated by factors associated with adequate tumor clearance (tumor size and proximity to the right sectoral portal pedicular structures), may be important for determining appropriate candidates for this aggressive resectional technique.