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

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 
Citation
 ANNALS OF SURGERY, Vol.278(5) : 748-755, 2023-11 
Journal Title
ANNALS OF SURGERY
ISSN
 0003-4932 
Issue Date
2023-11
MeSH
Benchmarking ; Hepatectomy / methods ; Humans ; Laparoscopy* / methods ; Length of Stay ; Liver Failure* / etiology ; Liver Neoplasms* / etiology ; Liver Neoplasms* / surgery ; Postoperative Complications / etiology ; Retrospective Studies
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. Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
Full Text
https://journals.lww.com/annalsofsurgery/fulltext/2023/11000/novel_benchmark_values_for_open_major_anatomic.16.aspx
DOI
10.1097/SLA.0000000000006012
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Park, Joon Seong(박준성) ORCID logo https://orcid.org/0000-0001-8048-9990
Lim, Jin Hong(임진홍)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/198388
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