Textbook Outcome After Major Liver Resection for Primary and Secondary Liver Tumors at Specialized German Hepatobiliary Centers: Analysis of the StuDoQ Liver Registry

Jan Heil¹, Svenja Sliwinski², Jan D'Haese^{3

4}, Josef Fangmann⁵, Stefan Farkas⁶, Robert Grützmann^{4

7}, Matthias Glanemann⁸, Jörg C Kalff⁹, Sören T Mees¹⁰, Arianeb Mehrabi¹¹, Christoph Michalski¹¹, Johann Pratschke¹², Christoph Reissfelder¹³, Maximilian Schmeding¹⁴, Matthias Schwarzbach¹⁵, Gregor A Stavrou^{4

16}, Jens Werner³, Carsten Klinger¹⁷, Heinz Buhr¹⁷, Wolf O Bechstein², Andreas A Schnitzbauer^{4

18}; DGAV StuDoQ-Registry

Affiliations

¹ Department of General and Visceral Surgery, Ulm University Hospital, Ulm, Germany. jan.heil@uniklinik-ulm.de.
² Department of General, Visceral, Transplant and Thoracic Surgery, University Hospital Frankfurt, Goethe University Frankfurt/Main, Frankfurt/Main, Germany.
³ Department of General, Visceral, and Transplantation Surgery, Hospital of the LMU Munich, Ludwig- Maximilians- Universität (LMU), Munich, Germany.
⁴ Chirurgische Arbeitsgemeinschaft für Leber-, Galle- und Pankreaserkrankungen der Deutschen Gesellschaft für Allgemein- und Viszeralchirurgie, Berlin, Germany.
⁵ KRH Klinikum Siloah, Liver Center Hannover (LCH), Hannover, Germany.
⁶ Department of Surgery, St. Josefs- Hospital, Wiesbaden, Germany.
⁷ Department of General and Visceral Surgery, Friedrich- Alexander- University (FAU) Erlangen- Nuernberg, Erlangen, Germany.
⁸ Department of General Surgery, Visceral-, Vascular- and Pediatric Surgery, Saarland University Medical Center, Homburg, Germany.
⁹ Department of Surgery, University Hospital Bonn, Campus 1, Bonn, Germany.
¹⁰ Department of General and Visceral Surgery, Dresden- Friedrichstadt General Hospital, Dresden, Germany.
¹¹ Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany.
¹² Charité- Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Campus Charité Mitte and Campus Virchow- Klinikum, Berlin, Germany.
¹³ Department of Surgery, Medical Faculty Mannheim, Universitätsmedizin Mannheim, Heidelberg University, Mannheim, Germany.
¹⁴ Department of Surgery, Klinikum Dortmund, University Hospital of the University Witten/Herdecke, Witten, Germany.
¹⁵ Department of General and Visceral Surgery, Klinikum Frankfurt Höchst, Frankfurt, Germany.
¹⁶ Department of General, Visceral and Thoracic Surgery, Surgical Oncology Klinikum Saarbruecken, Saarbruecken, Saarland, Germany.
¹⁷ StuDoQ Gremium Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie, Berlin, Germany.
¹⁸ Knappschaft Kliniken Universitätsklinikum Bochum, Ruhr-Universität-Bochum, Klinik für Chirurgie, Bochum, Germany.

PMID: 40760319
PMCID: PMC12454482
DOI: 10.1245/s10434-025-17866-w

Multicenter Study

Textbook Outcome After Major Liver Resection for Primary and Secondary Liver Tumors at Specialized German Hepatobiliary Centers: Analysis of the StuDoQ Liver Registry

Jan Heil et al. Ann Surg Oncol. 2025 Oct.

. 2025 Oct;32(10):7183-7194.

doi: 10.1245/s10434-025-17866-w. Epub 2025 Aug 4.

Authors

Affiliations

¹ Department of General and Visceral Surgery, Ulm University Hospital, Ulm, Germany. jan.heil@uniklinik-ulm.de.
² Department of General, Visceral, Transplant and Thoracic Surgery, University Hospital Frankfurt, Goethe University Frankfurt/Main, Frankfurt/Main, Germany.
³ Department of General, Visceral, and Transplantation Surgery, Hospital of the LMU Munich, Ludwig- Maximilians- Universität (LMU), Munich, Germany.
⁴ Chirurgische Arbeitsgemeinschaft für Leber-, Galle- und Pankreaserkrankungen der Deutschen Gesellschaft für Allgemein- und Viszeralchirurgie, Berlin, Germany.
⁵ KRH Klinikum Siloah, Liver Center Hannover (LCH), Hannover, Germany.
⁶ Department of Surgery, St. Josefs- Hospital, Wiesbaden, Germany.
⁷ Department of General and Visceral Surgery, Friedrich- Alexander- University (FAU) Erlangen- Nuernberg, Erlangen, Germany.
⁸ Department of General Surgery, Visceral-, Vascular- and Pediatric Surgery, Saarland University Medical Center, Homburg, Germany.
⁹ Department of Surgery, University Hospital Bonn, Campus 1, Bonn, Germany.
¹⁰ Department of General and Visceral Surgery, Dresden- Friedrichstadt General Hospital, Dresden, Germany.
¹¹ Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany.
¹² Charité- Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Campus Charité Mitte and Campus Virchow- Klinikum, Berlin, Germany.
¹³ Department of Surgery, Medical Faculty Mannheim, Universitätsmedizin Mannheim, Heidelberg University, Mannheim, Germany.
¹⁴ Department of Surgery, Klinikum Dortmund, University Hospital of the University Witten/Herdecke, Witten, Germany.
¹⁵ Department of General and Visceral Surgery, Klinikum Frankfurt Höchst, Frankfurt, Germany.
¹⁶ Department of General, Visceral and Thoracic Surgery, Surgical Oncology Klinikum Saarbruecken, Saarbruecken, Saarland, Germany.
¹⁷ StuDoQ Gremium Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie, Berlin, Germany.
¹⁸ Knappschaft Kliniken Universitätsklinikum Bochum, Ruhr-Universität-Bochum, Klinik für Chirurgie, Bochum, Germany.

PMID: 40760319
PMCID: PMC12454482
DOI: 10.1245/s10434-025-17866-w

Abstract

Background: Textbook outcome (TO) represents the most desirable outcome of surgical quality and care. This study examined the TO of cholangiocarcinoma (CCC), hepatocellular carcinoma (HCC), and colorectal liver metastasis (CRLM) from the StuDoQ liver registry as well as factors that may affect the TO.

Methods: All major liver resections (≥ 3 segments) for CCC, HCC, and CRLM entered in the multicentric StuDoQ liver registry between 2019 and 2022 were retrospectively analyzed. TO was defined by the absence of intraoperative incidents ≥ grade 2 (Oslo criteria), postoperative bile leakage and posthepatectomy liver failure (B/C, ISGLS criteria), major complications (Dindo-Clavien ≥ 3A), 90-day readmission, and mortality rate as well as tumor-free resection margin. Pre- and intraoperative factors that may influence TO were assessed by multivariable analyses.

Results: In 30 participating centers, a total of 1082 major liver resections were performed for CCC (n = 396, 36%), HCC (n = 214, 20%), and CRLM (n = 472, 44%). TO was achieved in 470 (43%) cases, most often in CRLM (51%). Major complications and intraoperative incidents ≥ 2 were the most frequent limiting factors to achieve TO. Anemia (odds ratio (OR) 0.63, 95% confidence interval (CI) 0.47-0.85), simultaneous resection procedures to the liver resection (OR 0.56, 95% CI 0.36-0.88), hyperbilirubinemia (OR 0.53, 95% CI 0.34-0.83), and cholangitis (OR 0.51, 95% CI 0.28-0.94) were identified as modifiable risk factors preventing achievement of a TO.

Conclusion: TO after major liver resection was achieved in less than 50% of cases in certified and high-volume HPB centers. Preoperative risk factors were identified that may allow to improve outcome quality.

Keywords: Cholangiocarcinoma; Colorectal liver metastasis; Hepatocellular carcinoma; Major hepatectomy; Outcome quality; Textbook outcome.

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Figures

**Fig. 2**
A Odds ratios for preoperative factors to achieve TO in the multivariable analysis. B Odds ratios for intraoperative factors to achieve TO in the multivariable analysis

See this image and copyright information in PMC

References

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Textbook Outcome After Major Liver Resection for Primary and Secondary Liver Tumors at Specialized German Hepatobiliary Centers: Analysis of the StuDoQ Liver Registry

Affiliations

Textbook Outcome After Major Liver Resection for Primary and Secondary Liver Tumors at Specialized German Hepatobiliary Centers: Analysis of the StuDoQ Liver Registry

Authors

Affiliations

Abstract

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References

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MeSH terms

LinkOut - more resources

Full Text Sources

Medical