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Safety and long‐term outcomes of anatomic left hepatic trisectionectomy for intermediate and advanced hepatocellular carcinoma
Author(s) -
Zheng Tao,
Xie Feng,
Geng Li,
Sui ChengJun,
Dai DingHua,
Shen RongXi,
Yan Long,
Yang JiaMei
Publication year - 2015
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.12887
Subject(s) - medicine , hepatocellular carcinoma , multivariate analysis , gastroenterology , cohort , retrospective cohort study , hepatectomy , liver function , surgery , carcinoma , resection
Background and Aim Anatomic left hepatic trisectionectomy ( ALHT ) is a complex hepatic resection, and its outcomes in hepatocellular carcinoma ( HCC ) still remain unclear. This paper focuses on the assessment of the safety and long‐term effects of ALHT on intermediate and advanced HCC patients with tumors that occupy the left liver lobe. Methods This study performed a retrospective analysis of consecutive HCC patients who underwent ALHT in a single‐center cohort between D ecember 2004 and D ecember 2011. Results ALHT was performed on 34 intermediate and advanced HCC patients (0.05%) of 17 064 HCC patients who had undergone hepatic resection. Among them, 12 (33.3%) developed postoperative complications. Based on the multivariate analysis, we found that a serum prealbumin level of 170 mg/L is associated with an increased risk of morbidity ( P = 0.008). The one‐year, two‐year, three‐year, and five‐year overall survival rates were 61%, 27%, 11%, and 11%, respectively. The median overall survival was 13 months (range, 2–89 months). Based on the multivariate analysis, we also found that patients with an A/G ratio < 1.5 are more likely to have poor prognosis than those with an A/G ratio ≥ 1.5 ( P = 0.014). Multiple tumors are associated with worse outcomes ( P = 0.020). Conclusions ALHT is safe for intermediate and advanced HCC patients with tumors that occupy the left lobe and with preoperative Child–Pugh class A liver function. Low preoperative serum prealbumin level may increase the risk of postoperative complications. Although early intrahepatic recurrence rate is high, some patients, especially those with a single tumor and normal A/G ratio, exhibit long‐term survival.