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Multicenter Study
. 2023 Nov 1;278(5):748-755.
doi: 10.1097/SLA.0000000000006012. Epub 2023 Jul 19.

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

Richard X Sousa Da Silva  1 , Eva Breuer  1 , Sadhana Shankar  2 , Shoji Kawakatsu  3 , Wacław Hołówko  4 , João Santos Coelho  5 , Heithem Jeddou  6 , Teiichi Sugiura  7 , Mohammed Ghallab  8 , Doris Da Silva  9 , Genki Watanabe  10 , Florin Botea  11 , Nozomu Sakai  12 , Pietro Addeo  13 , Stylianos Tzedakis  14 , Fabian Bartsch  15 , Kaja Balcer  16 , Chetana Lim  17 , Fabien Werey  18 , Victor Lopez-Lopez  19 , Luciana Peralta Montero  20 , Rodrigo Sanchez Claria  20 , Jennifer Leiting  21 , Neeta Vachharajani  22 , Eve Hopping  23 , Orlando J M Torres  24 , Satoshi Hirano  25 , Daan Andel  26 , Jeroen Hagendoorn  26 , Alicja Psica  27 , Matteo Ravaioli  28 , Keun Soon Ahn  29 , Tim Reese  30 , Leonardo A Montes  31 , Ganesh Gunasekaran  32 , Cándido Alcázar  33 , Jin Hong Lim  34 , Muhammad Haroon  35 , Qian Lu  36 , Antonio Castaldi  37 , Tatsuya Orimo  38 , Beat Moeckli  39 , Teresa Abadía  40 , Luis Ruffolo  41 , Josefina Dib Hasan  42 , Francesca Ratti  43 , Emmanuele F Kauffmann  44 , Roeland F de Wilde  45 , Wojciech G Polak  45 , Ugo Boggi  44 , Luca Aldrighetti  43 , Lucas McCormack  42 , Roberto Hernandez-Alejandro  41 , Alejandro Serrablo  40 , Christian Toso  39 , Akinobu Taketomi  38 , Jean Gugenheim  37 , Jiahong Dong  36 , Faisal Hanif  35 , Joon Seong Park  34 , José M Ramia  33 , Myron Schwartz  32 , Diego Ramisch  31 , Michelle L De Oliveira  1 , Karl J Oldhafer  30 , Koo Jeong Kang  29 , Matteo Cescon  28 , Peter Lodge  27 , Inne H M Borel Rinkes  26 , Takehiro Noji  25 , John-Edwin Thomson  23 , Su Kah Goh  23 , William C Chapman  22 , Sean P Cleary  21 , Juan Pekolj  20 , Jean-Marc Regimbeau  18 , Olivier Scatton  17 , Stéphanie Truant  16 , Hauke Lang  15 , David Fuks  14 , Philippe Bachellier  13 , Masayuki Ohtsuka  12 , Irinel Popescu  11 , Kiyoshi Hasegawa  10 , Mickaël Lesurtel  9 , René Adam  8 , Daniel Cherqui  8 , Katsuhiko Uesaka  7 , Karim Boudjema  6 , Hugo Pinto-Marques  5 , Michał Grąt  4 , Henrik Petrowsky  1 , Tomoki Ebata  3 , Andreas Prachalias  2 , Ricardo Robles-Campos  19 , Pierre-Alain Clavien  1
Affiliations
Multicenter Study

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

Richard X Sousa Da Silva et al. Ann Surg. .

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.

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Conflict of interest statement

The authors report no conflicts of interest.

Comment in

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