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

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

Published on: March 10, 2023

Left hepatic trisectionectomy for hepatobiliary malignancies.

Hauke Lang¹, Georgios C Sotiropoulos, Eirini I Brokalaki

¹Department of General Surgery, Visceral Surgery and Transplantation, University Hospital of Essen, Essen, Germany. hauke.lang@uni-essen.de

Journal of the American College of Surgeons

|August 26, 2006

Summary

Left hepatic trisectionectomy, an extensive liver resection, shows acceptable survival rates for advanced liver tumors. However, it carries significant risks, necessitating careful patient selection for optimal oncologic outcomes.

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Area of Science:

Hepatobiliary Surgery
Surgical Oncology
Gastroenterology

Background:

Left hepatic trisectionectomy is the most extensive form of liver resection.
Limited data exist on the long-term outcomes of this complex procedure.

Purpose of the Study:

To evaluate the long-term outcomes of patients undergoing left hepatic trisectionectomy.
To identify factors influencing survival and morbidity after this major liver surgery.

Main Methods:

A retrospective analysis of 52 patients who underwent left trisectionectomy between June 1998 and July 2004.
Data collected included patient characteristics, operative details, pathology, perioperative outcomes, and survival rates.

Main Results:

Operative morbidity was 50% and mortality was 11.9%. Additional procedures increased morbidity.
One-, three-, and five-year survival rates were 65%, 52%, and 33%, respectively.
R0 resection significantly improved survival (78% at 5 years) compared to R1 resection (7% at 5 years).

Conclusions:

Left hepatic trisectionectomy offers acceptable survival for advanced hepatobiliary malignancies and liver metastases.
The procedure is associated with higher mortality and morbidity than less extensive resections.
Clear selection criteria and focus on oncologic benefits are crucial for this operation.