학술논문
Novel Benchmark Values for Open Major Anatomic Liver Resection in Non-cirrhotic Patients: A Multicentric Study of 44 International Expert Centers
Document Type
Academic Journal
Author
Sousa Da Silva, Richard X.; Breuer, Eva; Shankar, Sadhana; Kawakatsu, Shoji; Hołówko, Wacław; Santos Coelho, João; Jeddou, Heithem; Sugiura, Teiichi; Ghallab, Mohammed; Da Silva, Doris; Watanabe, Genki; Botea, Florin; Sakai, Nozomu; Addeo, Pietro; Tzedakis, Stylianos; Bartsch, Fabian; Balcer, Kaja; Lim, Chetana; Werey, Fabien; Lopez-Lopez, Victor; Peralta Montero, Luciana; Sanchez Claria, Rodrigo; Leiting, Jennifer; Vachharajani, Neeta; Hopping, Eve; Torres, Orlando J. M.; Hirano, Satoshi; Andel, Daan; Hagendoorn, Jeroen; Psica, Alicja; Ravaioli, Matteo; Ahn, Keun Soon; Reese, Tim; Montes, Leonardo A.; Gunasekaran, Ganesh; Alcázar, Cándido; Lim, Jin Hong; Haroon, Muhammad; Lu, Qian; Castaldi, Antonio; Orimo, Tatsuya; Moeckli, Beat; Abadía, Teresa; Ruffolo, Luis; Dib Hasan, Josefina; Ratti, Francesca; Kauffmann, Emmanuele F.; de Wilde, Roeland F.; Polak, Wojciech G.; Boggi, Ugo; Aldrighetti, Luca; McCormack, Lucas; Hernandez-Alejandro, Roberto; Serrablo, Alejandro; Toso, Christian; Taketomi, Akinobu; Gugenheim, Jean; Dong, Jiahong; Hanif, Faisal; Park, Joon Seong; Ramia, José M.; Schwartz, Myron; Ramisch, Diego; De Oliveira, Michelle L.; Oldhafer, Karl J.; Kang, Koo Jeong; Cescon, Matteo; Lodge, Peter; Rinkes, Inne H. M. Borel; Noji, Takehiro; Thomson, John-Edwin; Goh, Su Kah; Chapman, William C.; Cleary, Sean P.; Pekolj, Juan; Regimbeau, Jean-Marc; Scatton, Olivier; Truant, Stéphanie; Lang, Hauke; Fuks, David; Bachellier, Philippe; Ohtsuka, Masayuki; Popescu, Irinel; Hasegawa, Kiyoshi; Lesurtel, Mickaël; Adam, René; Cherqui, Daniel; Uesaka, Katsuhiko; Boudjema, Karim; Pinto-Marques, Hugo; Grąt, Michał; Petrowsky, Henrik; Ebata, Tomoki; Prachalias, Andreas; Robles-Campos, Ricardo; Clavien, Pierre-Alain
Source
Annals of Surgery. Nov 01, 2023 278(5):748-755
Subject
Language
English
ISSN
0003-4932
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.