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

Sousa Da Silva, R. X.; Breuer, E.; Shankar, S.; Kawakatsu, S.; Holowko, W.; Santos Coelho, J.; Jeddou, H.; Sugiura, T.; Ghallab, M.; Da Silva, D.; Watanabe, G.; Botea, F.; Sakai, N.; Addeo, P.; Tzedakis, S.; Bartsch, F.; Balcer, K.; Lim, C.; Werey, F.; Lopez-Lopez, V.; Peralta Montero, L.; Sanchez Claria, R.; Leiting, J.; Vachharajani, N.; Hopping, E.; Torres, O. J. M.; Hirano, S.; Andel, D.; Hagendoorn, J.; Psica, A.; Ravaioli, M.; Ahn, K. S.; Reese, T.; Montes, L. A.; Gunasekaran, G.; Alcazar, C.; Lim, J. H.; Haroon, M.; Lu, Q.; Castaldi, A.; Orimo, T.; Moeckli, B.; Abadia, T.; Ruffolo, L.; Dib Hasan, J.; Ratti, F.; Kauffmann, E. F.; De Wilde, R. F.; Polak, W. G.; Boggi, U.; Aldrighetti, L.; Mccormack, L.; Hernandez-Alejandro, R.; Serrablo, A.; Toso, C.; Taketomi, A.; Gugenheim, J.; Dong, J.; Hanif, F.; Park, J. S.; Ramia, J. M.; Schwartz, M.; Ramisch, D.; De Oliveira, M. L.; Oldhafer, K. J.; Kang, K. J.; Cescon, M.; Lodge, P.; Rinkes, I. H. M. B.; Noji, T.; Thomson, J. -E.; Goh, S. K.; Chapman, W. C.; Cleary, S. P.; Pekolj, J.; Regimbeau, J. -M.; Scatton, O.; Truant, S.; Lang, H.; Fuks, D.; Bachellier, P.; Ohtsuka, M.; Popescu, I.; Hasegawa, K.; Lesurtel, M.; Adam, R.; Cherqui, D.; Uesaka, K.; Boudjema, K.; Pinto-Marques, H.; Grat, M.; Petrowsky, H.; Ebata, T.; Prachalias, A.; Robles-Campos, R.; Clavien, P. -A.

doi:10.1097/SLA.0000000000006012

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.

Novel Benchmark Values for Open Major Anatomic Liver Resection in Non-cirrhotic Patients: A Multicentric Study of 44 International Expert Centers / Sousa Da Silva, R. X.; Breuer, E.; Shankar, S.; Kawakatsu, S.; Holowko, W.; Santos Coelho, J.; Jeddou, H.; Sugiura, T.; Ghallab, M.; Da Silva, D.; Watanabe, G.; Botea, F.; Sakai, N.; Addeo, P.; Tzedakis, S.; Bartsch, F.; Balcer, K.; Lim, C.; Werey, F.; Lopez-Lopez, V.; Peralta Montero, L.; Sanchez Claria, R.; Leiting, J.; Vachharajani, N.; Hopping, E.; Torres, O. J. M.; Hirano, S.; Andel, D.; Hagendoorn, J.; Psica, A.; Ravaioli, M.; Ahn, K. S.; Reese, T.; Montes, L. A.; Gunasekaran, G.; Alcazar, C.; Lim, J. H.; Haroon, M.; Lu, Q.; Castaldi, A.; Orimo, T.; Moeckli, B.; Abadia, T.; Ruffolo, L.; Dib Hasan, J.; Ratti, F.; Kauffmann, E. F.; De Wilde, R. F.; Polak, W. G.; Boggi, U.; Aldrighetti, L.; Mccormack, L.; Hernandez-Alejandro, R.; Serrablo, A.; Toso, C.; Taketomi, A.; Gugenheim, J.; Dong, J.; Hanif, F.; Park, J. S.; Ramia, J. M.; Schwartz, M.; Ramisch, D.; De Oliveira, M. L.; Oldhafer, K. J.; Kang, K. J.; Cescon, M.; Lodge, P.; Rinkes, I. H. M. B.; Noji, T.; Thomson, J. -E.; Goh, S. K.; Chapman, W. C.; Cleary, S. P.; Pekolj, J.; Regimbeau, J. -M.; Scatton, O.; Truant, S.; Lang, H.; Fuks, D.; Bachellier, P.; Ohtsuka, M.; Popescu, I.; Hasegawa, K.; Lesurtel, M.; Adam, R.; Cherqui, D.; Uesaka, K.; Boudjema, K.; Pinto-Marques, H.; Grat, M.; Petrowsky, H.; Ebata, T.; Prachalias, A.; Robles-Campos, R.; Clavien, P. -A.. - In: ANNALS OF SURGERY. - ISSN 0003-4932. - 278:5(2023), pp. 748-755. [10.1097/SLA.0000000000006012]