Right (H145678) and Left (H123458) 6-Segmentectomies for Malignant Liver Tumors: A Retrospective Analysis of 237 Cases Using Contemporary Surgery Quality Indicators.

Abstract

Analysis of 6-segmentectomies coded H145678 or H123458 in the New World classification of liver resections using contemporary indicators to improve the shared surgical decision-making. Specific reports on H145678 and H123458 have lacked granularity or have focused on perihilar cancer. We performed a retrospective single-center analysis of consecutive patients who underwent H145678 or H123458 from 1993 to 2024. Surgical futility (90 d mortality), failure-to-rescue, oncological futility (early tumor recurrence), and outcome futility (surgical or oncologic futility) were evaluated. Textbook outcome achievement and the potential role of liver transplantation (LT) were also assessed. The study population included 237 patients with perihilar cholangiocarcinoma (n=117, 49.4%), intrahepatic cholangiocarcinoma (n=39, 16.4%), hepatocellular carcinoma (n=17, 7.2%), colorectal cancer liver metastases (n=38, 16.0%), or miscellaneous tumors (n=26, 11%). H145678 and H123458 were performed in 166 (70.0%) and 71 (30.0%) patients, respectively. Combined vascular and bile duct reconstructions were performed in 46.4% (n=110) and 62.4% (n=148) of patients, respectively. Rates of surgical, failure-to-rescue, oncological, and outcome futility were 15.6% (n=37), 30.3% (n=37), 14.5% (n=29), and 27.8% (n=66), respectively. Textbook outcome was achieved in 30.8% (n=73). With a median follow-up of 26 months, 5-year overall-survival rates and disease-free survival rates were 30.8% and 18.9%. LT criteria were not met in 94.9% (n=225). H123458 and H145678 offer selected patients a chance for long-term survival. LT is not a therapeutic option for most patients, and targeted rescue strategies may improve failure-to-rescue rates.