Novel Benchmark Values for Open Major Anatomic Liver Resection in Non-Cirrhotic Patients. A Multicentric Study of 44 International Expert Centers-Reference-Cited by-同舟云学术

Novel Benchmark Values for Open Major Anatomic Liver Resection in Non-Cirrhotic Patients. A Multicentric Study of 44 International Expert Centers

Published:2023-07-19 Issue: Volume: Page:
ISSN:0003-4932
Container-title:Annals of Surgery
language:en
Short-container-title:

Author:

Sousa Da Silva Richard X.¹,Breuer Eva¹,Shankar Sadhana²,Kawakatsu Shoji³,Hołówko Wacław⁴,Coelho João Santos⁵,Jeddou Heithem⁶,Sugiura Teiichi⁷,Ghallab Mohammed⁸,Da Silva Doris⁹,Watanabe Genki¹⁰,Botea Florin¹¹,Sakai Nozomu¹²,Addeo Pietro F.¹³,Tzedakis Stylianos¹⁴,Bartsch Fabian¹⁵,Balcer Kaja¹⁶,Lim Chetana¹⁷,Werey Fabien¹⁸,López Victor¹⁹,Montero Luciana Peralta²⁰,Claria Rodrigo Sanchez²⁰,Leiting Jennifer²¹,Vachharajani Neeta²²,Hopping Eve²³,Torres Orlando J. M.²⁴,Hirano Satoshi²⁵,Andel Daan²⁶,Hagendoorn Jeroen²⁶,Psica Alicja²⁷,Ravaioli Matteo²⁸,Ahn Keun S.²⁹,Reese Tim³⁰,Montes Leonardo Agustin³¹,Gunasekaran Ganesh³²,Alcázar Cándido³³,Lim Jin H.³⁴,Haroon Muhammad³⁵,Lu Qian³⁶,Castaldi Antonio³⁷,Orimo Tatsuya³⁸,Moeckli Beat³⁹,Abadía Teresa⁴⁰,Ruffolo Luis⁴¹,Hasan Josefina Dib⁴²,Ratti Francesca⁴³,Kaufmann Emmanuele F.⁴⁴,de Wilde Roeland⁴⁵,Polak Wojciech G.⁴⁵,Boggi Ugo⁴⁴,Aldrighetti Luca⁴³,McCormack Lucas⁴²,Hernandez-Alejandro Roberto⁴¹,Serrablo Alejandro⁴⁰,Toso Christian³⁹,Taketomi Akinobu³⁸,Gugenheim Jean³⁷,Dong Jiahong³⁶,Hanif Faisal³⁵,Park Joon S.³⁴,Ramia José M.³³,Schwartz Myron³²,Ramisch Diego³¹,De Oliveira Michelle¹,Oldhafer Karl J.³⁰,Kang Koo J.²⁹,Cescon Matteo²⁸,Lodge Peter²⁷,Rinkes Inne H. M. Borel²⁶,Noji Takehiro²⁵,Thomson John-Edwin²³,Goh Su K.²³,Chapman William C.²²,Cleary Sean P.²¹,Pekolj Juan²⁰,Regimbeau Jean-Marc¹⁸,Scatton Olivier¹⁷,Truant Stéphanie¹⁶,Lang Hauke¹⁵,Fuks David¹⁴,Bachellier Philippe¹³,Otsuka Masayuki¹²,Popescu Irinel¹¹,Hasegawa Kiyoshi¹⁰,Lesurtel Mickaël⁹,Adam René⁸,Cherqui Daniel⁸,Uesaka Katsuhiko⁷,Boudjema Karim⁶,Marques Hugo Pinto⁵,Grąt Micha⁴,Petrowsky Henrik¹,Ebata Tomoki³,Prachalias Andreas²,Robles-Campos Ricardo¹⁹,Clavien Pierre-Alain¹

Affiliation:

1. Swiss HPB and Transplant Center Zurich, Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland

2. Department of Hepatobiliary and Pancreatic Surgery, King’s College Hospital, London, UK

3. Department of Surgical Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan

4. Department of General, Transplant and Liver Surgery, Medical University Warsaw, Warsaw, Poland

5. Hepato-Biliary-Pancreatic and Transplantation Centre, Curry Cabral Hospital, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal

6. Department of Hepatobiliary and Digestive Surgery, Rennes University Hospital, Rennes, France

7. Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan

8. The Centre Hépato-Biliaire, Cancer and Transplantation Unit, AP-HP Paul Brousse Hospital, University Paris-Saclay, Villejuif, France

9. Department of HPB Surgery and Liver Transplantation, AP-HP Beaujon Hospital, University of Paris Cité, Clichy, France

10. Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

11. Department of Surgery and Transplantation, Fundeni Clinical Institute, Bucharest, Romania

12. Department of General Surgery, Chiba University, Graduate School of Medicine, Chiba, Japan

13. Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University Hospital, Strasbourg University, Strasbourg, France

14. Department of Digestive, Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France

15. Department of General, Visceral and Transplantation Surgery, University Hospital of Mainz, Mainz, Germany

16. Department of Digestive Surgery and Transplantation, CHU Lille, University Lille, Lille, France

17. Department of Digestive, Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtriere, Sorbonne Université, Centre de Recherche de Saint-Antoine, Paris, France

18. Department of Oncology and Digestive Surgery, CHU Amiens-Picardie, Amiens, France

19. Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de la Arrixaca, Murcia, Spain

20. Hepato-Pancreato-Biliary Surgery Section and Liver Transplant Unit, General Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

21. Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, MN, USA

22. Department of Surgery, Section of Abdominal Organ Transplant, Washington University School of Medicine, St Louis, MO, USA

23. Hepatobiliary Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide & Hepatobiliary Unit, Department of Surgery, Flinders Medical Centre, Adelaide, Australia

24. Department of Gastrointestinal Surgery, Hepatopancreatobiliary Unit, Presidente Dutra Hospital, São Luiz, Brazil

25. Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, Hokkaido, Japan

26. Department of Surgical Oncology, University Medical Center Utrecht Cancer Center, Utrecht, The Netherlands

27. Department of Transplantation and Hepatobiliary Surgery, Leeds Teaching Hospital NHS Trust, Leeds, UK

28. Department of General Surgery and Transplantation, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy

29. Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, School of Medicine, Keimyung University, Dongsan Hospital, Daegu, Republic of Korea

30. Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, Asklepios Hospital Barmbek, Semmelweis University of Medicine, Asklepios Campus Hamburg, Hamburg, Germany

31. General Surgery Department Liver, Pancreas and Intestinal Transplant Unit, Favaloro Foundation University Hospital, Buenos Aires, Argentina

32. Department of Surgery, Division of HPB Service, Icahn School of Medicine at Mount Sinai, New York, NY

33. Department of Surgery, HPB and Transplant Unit, General Universitary Hospital Alicante and Health and Biomedical Research Institute of Alicante, Alicante, Spain

34. Department of Surgery, Division of HBP Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea

35. Department of HPB and Liver Transplant, Bahria International Hospital Orchard, Lahore, Pakistan

36. Department of Hepatobiliary and Pancreas Surgery, Beijing Tsinghua Changgung Hospital, Tsinghua University School of Clinical Medicine, Beijing, China

37. Department of Digestive Surgery and Liver Transplant Unit, University Côte d’Azur, CHU de Nice, Nice, France

38. Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Hokkaido, Japan

39. Division of Abdominal and Transplantation Surgery, University Hospitals of Geneva, Geneva, Switzerland

40. HPB Surgical Division, Miguel Servet University Hospital, Zaragoza, Spain

41. Department of HPB and Transplant Surgery, University of Rochester, Rochester, NY

42. Transplant Unit, Hospital Aleman de Buenos Aires, Buenos Aires, Argentina

43. Division of Hepatobiliary Surgery, IRCCS San Raffaele Hospital, Vita - Salute University, Milan, Italy

44. Division of General and Transplant Surgery, University of Pisa, Pisa, Italy

45. Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands

Abstract

Objective: This study aims at establishing benchmark values for best achievable outcomes following open major anatomic hepatectomy for liver tumors of all dignities. Background: Outcomes after open major hepatectomies vary widely lacking reference values for comparisons among centers, indications, types of resections, and minimally invasive procedures. Methods: A standard benchmark methodology was used covering consecutive patients, who underwent open major anatomic hepatectomy from 44 high-volume liver centers from 5 continents over a five-year period (2016–2020). Benchmark cases were low-risk non-cirrhotic patients without significant co-morbidities treated in high-volume centers (≥30 major liver resections/year). Benchmark values were set at the 75th percentile of median values of all centers. Minimum follow-up period was 1 year in each patient. Results: Of 8044 patients, 2908 (36%) qualified as benchmark (low risk) cases. Benchmark cutoffs for all indications include R0 resection ≥78%; liver failure (grade B/C) ≤10%; bile leak (grade B/C) ≤18%; complications ≥grade 3 and CCI® ≤46% and ≤9 at 3 months, respectively. Benchmark values differed significantly between malignant and benign conditions so that reference values must be adjusted accordingly. Extended right hepatectomy (H1,4-8 or H4-8) disclosed higher cutoff for liver failure, while extended left (H1-5,8 or H2-5,8) were associated with higher cutoffs for bile leaks, but had superior oncologic outcomes, when compared to formal left hepatectomy (H1-4 or H2-4). The minimal follow up for a conclusive outcome evaluation following open anatomic major resection must be 3 months. Conclusion: These new benchmark cut-offs for open major hepatectomy provide a powerful tool to convincingly evaluate other approaches including parenchymal-sparing procedures, laparoscopic/robotic approaches, and alternative treatments, such as ablation therapy, irradiation or novel chemotherapy regimens.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Surgery