Defining Global Benchmarks for Laparoscopic Liver Resections: An International Multicenter Study
Authors
Brian K P Goh ; Ho-Seong Han ; Kuo-Hsin Chen ; Darren W Chua ; Chung-Yip Chan ; Federica Cipriani ; Davit L Aghayan ; Asmund A Fretland ; Jasper Sijberden ; Mizelle D'Silva ; Tiing Foong Siow ; Yutaro Kato ; Chetana Lim ; Phan Phuoc Nghia ; Paulo Herman ; Marco V Marino ; Vincenzo Mazzaferro ; Adrian K H Chiow ; Iswanto Sucandy ; Arpad Ivanecz ; Sung Hoon Choi ; Jae Hoon Lee ; Mikel Gastaca ; Marco Vivarelli ; Felice Giuliante ; Andrea Ruzzenente ; Chee-Chien Yong ; Mengqui Yin ; Zewei Chen ; Constantino Fondevila ; Mikhail Efanov ; Fernando Rotellar ; Gi-Hong Choi ; Ricardo R Campos ; Xiaoying Wang ; Robert P Sutcliffe ; Johann Pratschke ; Eric Lai ; Charing C Chong ; Mathieu D'Hondt ; Kazuteru Monden ; Santiago Lopez-Ben ; Fabricio F Coelho ; Thomas Peter Kingham ; Rong Liu ; Tran Cong Duy Long ; Alessandro Ferrero ; Giovanni B Levi Sandri ; Mansour Saleh ; Daniel Cherqui ; Olivier Scatton ; Olivier Soubrane ; Go Wakabayashi ; Roberto I Troisi ; Tan-To Cheung ; Atsushi Sugioka ; Mohammad Abu Hilal ; David Fuks ; Bjørn Edwin ; Luca Aldrighetti
Citation
ANNALS OF SURGERY, Vol.277(4) : e839-e848, 2023-04
Objective: To establish global benchmark outcomes indicators after laparoscopic liver resections (L-LR).
Background: There is limited published data to date on the best achievable outcomes after L-LR.
Methods: This is a post hoc analysis of a multicenter database of 11,983 patients undergoing L-LR in 45 international centers in 4 continents between 2015 and 2020. Three specific procedures: left lateral sectionectomy (LLS), left hepatectomy (LH), and right hepatectomy (RH) were selected to represent the 3 difficulty levels of L-LR. Fifteen outcome indicators were selected to establish benchmark cutoffs.
Results: There were 3519 L-LR (LLS, LH, RH) of which 1258 L-LR (40.6%) cases performed in 34 benchmark expert centers qualified as low-risk benchmark cases. These included 659 LLS (52.4%), 306 LH (24.3%), and 293 RH (23.3%). The benchmark outcomes established for operation time, open conversion rate, blood loss ≥500 mL, blood transfusion rate, postoperative morbidity, major morbidity, and 90-day mortality after LLS, LH, and RH were 209.5, 302, and 426 minutes; 2.1%, 13.4%, and 13.0%; 3.2%, 20%, and 47.1%; 0%, 7.1%, and 10.5%; 11.1%, 20%, and 50%; 0%, 7.1%, and 20%; and 0%, 0%, and 0%, respectively.
Conclusions: This study established the first global benchmark outcomes for L-LR in a large-scale international patient cohort. It provides an up-to-date reference regarding the "best achievable" results for L-LR for which centers adopting L-LR can use as a comparison to enable an objective assessment of performance gaps and learning curves.