ORIGINAL ARTICLE Liver trisectionectomies for primary and secondary liver cancer in the modern era: results of a single tertiary center Nadia Russolillo • Alessandro Ferrero • Luca Vigano ` • Serena Langella • Marco Amisano • Lorenzo Capussotti Received: 25 November 2010 / Accepted: 30 November 2010 / Published online: 16 December 2010 Ó Springer-Verlag 2010 Abstract Recent advances in patient selection and sur- gical technique have resulted in low mortality and mor- bidity rates after liver resections. The aim of this study was to evaluate the operative risks of liver trisectionectomies in comparison with major resections. The data prospectively collected of patients who underwent trisectionectomies (TR Group, n = 54) and major hepatectomies (MH Group, n = 175) without biliary reconstruction were compared. Besides, the early results of patients who underwent right trisectionectomies (RTR Group, n = 36) and left trisec- tionectomies (LTR Group, n = 18) were compared. There was no significant difference in patient characteristics of MH and TR groups excluded for a high portal vein embolization (PVE) in TR group. Mortality (1% in MH group and 3.7% in TR group, p = 0.206) and overall morbidity rates (39% in MH group and 48% in TR group, p = 0.225) were similar between two groups. A higher proportion of patients in TR group developed liver failure (p = 0.024) and required blood transfusion (30 vs. 11%, p \ 0.001). The median hospital stay after trisectionecto- mies was higher in TR group than MH group (p = 0.053). There was no significant difference in patient characteris- tics of LTR and RTR groups excluded for lymphadenec- tomy which was higher in LTR group (p = 0.008) and PVE rate higher in RTR group (p = 0.01). The overall morbidity (44 vs. 55%) and mortality (2.7 vs. 5.5%) were comparable between two groups. A higher proportion of patients in RTR group required blood transfusion (39 vs. 11%, p = 0.032). At multivariate analysis, age was the only positive predictor for morbidity after trisectionecto- mies (p = 0.010). Trisectionectomies can be performed safely. Left trisectionectomies are as safe as right trisec- tionectomies. The accurate preoperative selection is nec- essary to reduce operative risks. Keywords Liver trisectionectomy Á Major hepatectomy Á Elderly patients Introduction Liver trisectionectomies may be the only means avail- able to achieve complete resection in some patients with multiple or large tumors. Trisectionectomy is a major surgical procedure that carries substantial operative risks. In the past decade, some authors reported large series of trisectionectomies with perioperative mortality rates between 6.9 and 10.8% [1–4] and morbidity rates C50% [3–6]. Recent advances in patient selection and surgical technique have resulted in low mortality and morbidity rates after liver resection [6–10]. Multiple factors are responsible for the marked improvement in perioperative outcome such as the emergence of tertiary hepatobiliary departments, better preoperative patient’s selection and improved anesthetic and surgical tech- niques [6, 7]. The aim of this study was to evaluate the operative risks of liver trisectionectomies in comparison with major resections. In addition, early results of right and left tri- sectionectomies were compared in order to evaluate any difference between the two procedures, and we investi- gated factors affecting morbidity after trisectionectomies. N. Russolillo (&) Á A. Ferrero Á L. Vigano ` Á S. Langella Á M. Amisano Á L. Capussotti Department HPB and Digestive Surgery, Ospedale Mauriziano ‘‘Umberto I’’, Largo Turati, 620-10128 Turin, Italy e-mail: nadia.russolillo@libero.it 123 Updates Surg (2010) 62:161–169 DOI 10.1007/s13304-010-0038-3