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


Journal

Annals of surgery
ISSN: 1528-1140
Titre abrégé: Ann Surg
Pays: United States
ID NLM: 0372354

Informations de publication

Date de publication:
01 11 2023
Historique:
medline: 6 10 2023
pubmed: 19 7 2023
entrez: 19 7 2023
Statut: ppublish

Résumé

This study aims at establishing benchmark values for best achievable outcomes following open major anatomic hepatectomy for liver tumors of all dignities. Outcomes after open major hepatectomies vary widely lacking reference values for comparisons among centers, indications, types of resections, and minimally invasive procedures. 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. 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. 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.

Sections du résumé

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.

Identifiants

pubmed: 37465950
doi: 10.1097/SLA.0000000000006012
pii: 00000658-202311000-00016
doi:

Types de publication

Multicenter Study Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

748-755

Informations de copyright

Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

Déclaration de conflit d'intérêts

The authors report no conflicts of interest.

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Auteurs

Richard X Sousa Da Silva (RX)

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

Eva Breuer (E)

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

Sadhana Shankar (S)

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

Shoji Kawakatsu (S)

Division of Surgical Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan.

Wacław Hołówko (W)

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

João Santos Coelho (J)

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

Heithem Jeddou (H)

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

Teiichi Sugiura (T)

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

Mohammed Ghallab (M)

Paul Brousse Hospital, AP-HP, University Paris-Saclay, Villejuif, France.

Doris Da Silva (D)

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

Genki Watanabe (G)

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

Florin Botea (F)

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

Nozomu Sakai (N)

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

Pietro Addeo (P)

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

Stylianos Tzedakis (S)

Department of Hepatobiliary, Digestive and Endocrine Surgery, Cochin Hospital, Paris Cité University, Paris, France.

Fabian Bartsch (F)

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

Kaja Balcer (K)

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

Chetana Lim (C)

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

Fabien Werey (F)

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

Victor Lopez-Lopez (V)

Clinic and University Virgen de la Arrixaca Hospital, IMIB, Murcia, Spain.

Luciana Peralta Montero (L)

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

Rodrigo Sanchez Claria (R)

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

Jennifer Leiting (J)

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

Neeta Vachharajani (N)

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

Eve Hopping (E)

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

Orlando J M Torres (OJM)

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

Satoshi Hirano (S)

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

Daan Andel (D)

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

Jeroen Hagendoorn (J)

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

Alicja Psica (A)

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

Matteo Ravaioli (M)

Hepato-biliary surgery and Transplant Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.

Keun Soon Ahn (KS)

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

Tim Reese (T)

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

Leonardo A Montes (LA)

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

Ganesh Gunasekaran (G)

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

Cándido Alcázar (C)

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

Jin Hong Lim (JH)

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

Muhammad Haroon (M)

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

Qian Lu (Q)

Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.

Antonio Castaldi (A)

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

Tatsuya Orimo (T)

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

Beat Moeckli (B)

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

Teresa Abadía (T)

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

Luis Ruffolo (L)

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

Josefina Dib Hasan (J)

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

Francesca Ratti (F)

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

Emmanuele F Kauffmann (EF)

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

Roeland F de Wilde (RF)

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

Wojciech G Polak (WG)

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

Ugo Boggi (U)

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

Luca Aldrighetti (L)

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

Lucas McCormack (L)

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

Roberto Hernandez-Alejandro (R)

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

Alejandro Serrablo (A)

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

Christian Toso (C)

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

Akinobu Taketomi (A)

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

Jean Gugenheim (J)

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

Jiahong Dong (J)

Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.

Faisal Hanif (F)

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

Joon Seong Park (JS)

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

José M Ramia (JM)

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

Myron Schwartz (M)

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

Diego Ramisch (D)

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

Michelle L De Oliveira (ML)

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

Karl J Oldhafer (KJ)

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

Koo Jeong Kang (KJ)

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

Matteo Cescon (M)

Hepato-biliary surgery and Transplant Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.

Peter Lodge (P)

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

Inne H M Borel Rinkes (IHMB)

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

Takehiro Noji (T)

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

John-Edwin Thomson (JE)

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

Su Kah Goh (SK)

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

William C Chapman (WC)

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

Sean P Cleary (SP)

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

Juan Pekolj (J)

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

Jean-Marc Regimbeau (JM)

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

Olivier Scatton (O)

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

Stéphanie Truant (S)

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

Hauke Lang (H)

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

David Fuks (D)

Department of Hepatobiliary, Digestive and Endocrine Surgery, Cochin Hospital, Paris Cité University, Paris, France.

Philippe Bachellier (P)

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

Masayuki Ohtsuka (M)

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

Irinel Popescu (I)

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

Kiyoshi Hasegawa (K)

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

Mickaël Lesurtel (M)

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

René Adam (R)

Paul Brousse Hospital, AP-HP, University Paris-Saclay, Villejuif, France.

Daniel Cherqui (D)

Paul Brousse Hospital, AP-HP, University Paris-Saclay, Villejuif, France.

Katsuhiko Uesaka (K)

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

Karim Boudjema (K)

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

Hugo Pinto-Marques (H)

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

Michał Grąt (M)

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

Henrik Petrowsky (H)

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

Tomoki Ebata (T)

Division of Surgical Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan.

Andreas Prachalias (A)

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

Ricardo Robles-Campos (R)

Clinic and University Virgen de la Arrixaca Hospital, IMIB, Murcia, Spain.

Pierre-Alain Clavien (PA)

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

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