Safety and long‐term outcomes of anatomic left hepatic trisectionectomy for intermediate and advanced hepatocellular carcinoma

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 December 2004 and December 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.