Novel Benchmark Values for Open Major Anatomic Liver Resection in Non-cirrhotic Patients
Year: 2023
Type: article
Study design: Observational Study
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 5-year period (2016-2020). Benchmark cases were low-risk non-cirrhotic patients without significant comorbidities 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 a 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 cutoffs 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.
Source: Annals of Surgery
Authors: Richard X. Sousa Da Silva, Eva Breuer, Sadhana Shankar, Shoji Kawakatsu, Wacław Hołówko, João Santos Coelho, Heithem Jeddou, Teiichi Sugiura, Mohammed Ghallab, Doris Da Silva, Genki Watanabe, Florin Botea, Nozomu Sakai, Pietro Addeo, Stylianos Tzedakis, Fabian Bartsch, Kaja Balcer, Chetana Lim, Fabien Werey, Victor Lopez-Lopez, Luciana Peralta Montero, Rodrigo Sanchez Claria, Jennifer Leiting, Neeta Vachharajani, Eve Hopping, Orlando J. M. Torres, Satoshi Hirano, Daan Andel, Jeroen Hagendoorn, Alicja Psica, Matteo Ravaioli, Keun Soon Ahn, Tim Reese, Leonardo A. Montes, Ganesh Gunasekaran, Cándido Alcázar, Jin Hong Lim, Muhammad Haroon, Qian Lu, Antonio Castaldi, Tatsuya Orimo, Beat Moeckli, Teresa Abadía, Luis Ruffolo, Josefina Dib Hasan, Francesca Ratti, Emmanuele F. Kauffmann, Roeland F. de Wilde, Wojciech G. Polak, Ugo Boggi, Luca Aldrighetti, Lucas McCormack, Roberto Hernandez-Alejandro, Alejandro Serrablo, Christian Toso, Akinobu Taketomi, Jean Gugenheim, Jiahong Dong, Faisal Hanif, Joon Seong Park, José M. Ramia, Myron Schwartz, Diego Ramisch, Michelle L. De Oliveira, Karl J. Oldhafer, Koo Jeong Kang, Matteo Cescon, Peter Lodge, Inne H. M. Borel Rinkes, Takehiro Noji, John-Edwin Thomson, Su Kah Goh, William C. Chapman, Sean P. Cleary, Juan Pekolj, Jean-Marc Regimbeau, Olivier Scatton, Stéphanie Truant, Hauke Lang, David Fuks, Philippe Bachellier, Masayuki Ohtsuka, Irinel Popescu, Kiyoshi Hasegawa, Mickaël Lesurtel, René Adam, Daniel Cherqui, Katsuhiko Uesaka, Karim Boudjema, Hugo Pinto-Marques, Michał Grąt, Henrik Petrowsky, Tomoki Ebata, Andreas Prachalias, Ricardo Robles-Campos, Pierre-Alain Clavien
Institutions: University Hospital Zurich, King's College Hospital, Nagoya University, Medical University of Warsaw, Unidade Local de Saúde de São José, Hospital Curry Cabral, Centre Hospitalier Universitaire de Rennes, Shizuoka Cancer Center, Université Paris-Saclay, Assistance Publique – Hôpitaux de Paris, Hôpital Paul-Brousse, Université Paris Cité, Hôpital Beaujon, The University of Tokyo, Institutul Clinic Fundeni, Chiba University, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Institute Mutualiste Montsouris, Hôpital Cochin, Université Paris Descartes, University Medical Center of the Johannes Gutenberg University Mainz, Université de Lille, Centre Hospitalier Universitaire de Lille, Sorbonne Université, Pitié-Salpêtrière Hospital, Centre de Recherche Saint-Antoine, Centre Hospitalier Universitaire Amiens-Picardie, Instituto Murciano de Investigación Biosanitaria, Hospital Universitario Virgen de la Arrixaca, Hospital Italiano de Buenos Aires, Mayo Clinic, Washington University in St. Louis, Royal Adelaide Hospital, Flinders Medical Centre, Hokkaido University, Utrecht University, University Medical Center Utrecht, Leeds Teaching Hospitals NHS Trust, IRCCS Azienda Ospedliero-Universitaria di Bologna Policlinico di Sant'Orsola, University of Bologna, Keimyung University Dongsan Hospital, Keimyung University, Asklepios Klinik Barmbek, Favaloro University, Fundacion Favaloro Hospital Universitario, Favaloro Foundation, Icahn School of Medicine at Mount Sinai, Hospital General Universitario de Alicante Doctor Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Yonsei University, Gangnam Severance Hospital, Yonsei University Health System, Beijing Tsinghua Chang Gung Hospital, Tsinghua University, Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, University Hospital of Geneva, Hospital Universitario Miguel Servet, University of Rochester Medicine, University of Rochester, Hospital Alemán, Vita-Salute San Raffaele University, IRCCS Ospedale San Raffaele, Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele, University of Pisa, Erasmus MC, Erasmus MC Transplant Institute
Language: English
Subfield: Hepatology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W4384664475