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. 2022 Aug;24(8):1365-1375.
doi: 10.1016/j.hpb.2022.02.008. Epub 2022 Mar 1.

Benchmarking postoperative outcomes after open liver surgery for cirrhotic patients with hepatocellular carcinoma in a national cohort

Simone Famularo  1 , Nadia Russolillo  2 , Matteo Donadon  3 , Federica Cipriani  4 , Francesco Ardito  5 , Pasquale Perri  6 , Alessandro Giani  7 , Francesca De Stefano  8 , Quirino Lai  9 , Sarah Molfino  10 , Matteo Zanello  11 , Maurizio Iaria  12 , Giuliano La Barba  13 , Enrico Pinotti  14 , Paola Germani  15 , Simone Conci  16 , Cecilia Ferrari  17 , Luca Fumagalli  18 , Maurizio Romano  19 , Adelmo Antonucci  20 , Giuseppe Zimmitti  21 , Albert Troci  22 , Antonio Floridi  23 , Valentina Ferraro  24 , Stefan Patauner  25 , Antonio Frena  25 , Riccardo Memeo  24 , Michele Crespi  22 , Mohammed A Hilal  21 , Giacomo Zanus  19 , Marco Chiarelli  18 , Andrea Percivale  17 , Andrea Ruzzenente  16 , Paola Tarchi  15 , Mauro Zago  26 , Giorgio Ercolani  13 , Raffaele Dalla Valle  12 , Elio Jovine  11 , Gian Luca Baiocchi  10 , Massimo Rossi  9 , Marcello Maestri  8 , Fabrizio Romano  7 , Gian Luca Grazi  6 , Felice Giuliante  5 , Luca Aldrighetti  4 , Alessandro Ferrero  2 , Guido Torzilli  27 ; HE.RC.O.LE.S. Group, HERCOLES GROUP Contributors
Collaborators, Affiliations
Free article

Benchmarking postoperative outcomes after open liver surgery for cirrhotic patients with hepatocellular carcinoma in a national cohort

Simone Famularo et al. HPB (Oxford). 2022 Aug.
Free article

Abstract

Background: Benchmark analysis for open liver surgery for cirrhotic patients with hepatocellular carcinoma (HCC) is still undefined.

Methods: Patients were identified from the Italian national registry HE.RC.O.LE.S. The Achievable Benchmark of Care (ABC) method was employed to identify the benchmarks. The outcomes assessed were the rate of complications, major comorbidities, post-operative ascites (POA), post-hepatectomy liver failure (PHLF), 90-day mortality. Benchmarking was stratified for surgical complexity (CP1, CP2 and CP3).

Results: A total of 978 of 2698 patients fulfilled the inclusion criteria. 431 (44.1%) patients were treated with CP1 procedures, 239 (24.4%) with CP2 and 308 (31.5%) with CP3 procedures. Patients submitted to CP1 had a worse underlying liver function, while the tumor burden was more severe in CP3 cases. The ABC for complications (13.1%, 19.2% and 28.1% for CP1, CP2 and CP3 respectively), major complications (7.6%, 11.1%, 12.5%) and 90-day mortality (0%, 3.3%, 3.6%) increased with the surgical difficulty, but not POA (4.4%, 3.3% and 2.6% respectively) and PHLF (0% for all groups).

Conclusion: We propose benchmarks for open liver resections in HCC cirrhotic patients, stratified for surgical complexity. The difference between the benchmark values and the results obtained during everyday practice reflects the room for potential growth, with the aim to encourage constant improvement among liver surgeons.

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