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Updated: Jun 25, 2026

Application of the En Bloc Concept Combined with Anatomic Resection in Laparoscopic Hepatectomy
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Application of the En Bloc Concept Combined with Anatomic Resection in Laparoscopic Hepatectomy

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Extended left hepatectomy.

S P Povoski1, Y Fong, L H Blumgart

  • 1Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, New York 10021, USA.

World Journal of Surgery
|November 7, 1999
PubMed
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Extended left hepatectomy enables removal of complex liver tumors. While associated with increased risks, careful patient selection ensures its safe and effective application for previously unresectable lesions.

Area of Science:

  • Hepatobiliary Surgery
  • Surgical Oncology
  • Liver Transplantation

Background:

  • Extended left hepatectomy, involving resection of liver segments II, III, IV, V, and VIII, is an advanced surgical technique.
  • This procedure addresses large, centrally located liver lesions that may involve the right anterior sectoral portal pedicular structures.

Purpose of the Study:

  • To evaluate the safety and efficacy of extended left hepatectomy for challenging liver lesions.
  • To identify predictors of outcomes in patients undergoing this extensive liver resection.

Main Methods:

  • Retrospective analysis of 51 patients who underwent extended left hepatectomy between 1992 and 1998.
  • Review of preoperative, intraoperative, and postoperative data, including patient demographics, lesion characteristics, and outcomes.

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  • Multivariate analysis to identify independent predictors of margin status and postoperative complications.

    • Main Results:

    • The study included 51 patients (median age 58) with various liver lesions (34 metastatic, 14 primary, 3 benign).
    • Postoperative morbidity was 53% and mortality was 8%, with a median hospital stay of 10 days.
    • Lesion size >8 cm was the only independent predictor of positive margins; no variables predicted morbidity or mortality.

    Conclusions:

    • Extended left hepatectomy is a viable option for resecting complex liver lesions previously considered unresectable.
    • The procedure carries increased risks but can be performed safely with careful patient selection.
    • Tumor size and proximity to vascular structures are critical factors in patient selection for this aggressive technique.