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Defining Benchmarks for Major Liver Surgery - A multicenter analysis of 5202 living liver donors
Fabian Rössler*1, Gonzalo Sapisochin*2, GiWon Song*3, Yu-Hung Lin*4, Mary Anne Simpson*5, Kiyoshi Hasegawa*6, Andrea Laurenzi*7, Santiago Sanchez Cabús*8, Milton Inostroza Nunez*9, Andrea Gatti*10, Magali Chahdi Beltrame*11, Ksenija Slankamenac*1, Paul Greig*2, Sung-Gyu Lee*3, Chao-Long Chen*4, David Grant2, Elisabeth A. Pomfret*5, Norihiro Kokudo*6, Daniel Cherqui7, Kim Olthoff12, Avi Shaked*12, Juan Carlos García-Valdecasas*8, Jan Lerut*9, Roberto Troisi*10, Martin De Santibanes*11, Milo Puhan*13, Henrik Petrowsky*1, Pierre-Alain Clavien*1
1Swiss HPB Center Zurich, Department of Surgery, University Hospital Zurich, Zurich, Switzerland2Department of Surgery, Toronto General Hospital, Toronto, ON, Canada3Department of Surgery, University of Ulsan College of Medicine, Seoul, Korea, Republic of4Department of Surgery, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Kaohsiung, Taiwan5Department of Transplantation, Lahey Hospital and Medical Center, Burlington, MA;6Artificial Organ and Transplantation Division and Hepato-Biliary-Pancreatic Surgery, University of Tokyo, Tokyo, Japan7The Hepatobiliary Center, Department of Surgery, Paul Brousse Hospital, University Paris Sud, Villejuif, France8Department of Surgery, Hospital Clínic de Barcelona, Barcelona, Spain9Department of Abdominal and Transplantation Surgery, University Hospitals Saint Luc, Brussels, Belgium10Department of General Hepatobiliary and Liver Transplantation Surgery, Ghent University Hospital and Medical School, Ghent, Belgium11Department of Surgery, Division of HPB Surgery, Liver Transplant Unit, Italian Hospital Buenos Aires, Buenos Aires, Argentina12Department of Liver Transplant and Hepatobiliary Surgery, University of Pennsylvania Health System, Philadelphia, PA;13Department of Epidemiology, Institute for Social and Preventive Medicine, University of Zurich, Zurich, Switzerland

OBJECTIVE(S):
To measure and define best achievable outcome following major hepatectomy.
BACKGROUND:
Analysis in living liver donors, in whom minimizing complications has highest priority, offers the opportunity to define outcome benchmarks as the best possible results.
METHODS:
Outcome analyses of 5202 consecutive anatomic right (n=4206) and left (n=996) hemihepatectomies from 12 high-volume centers worldwide were performed over a 10-year period. Endpoints included intra and up to 6m postoperative parameters including Clavien-Dindo classification and the comprehensive complication index (CCI) measuring the overall morbidity from zero (uneventful) to 100 (death).
RESULTS:
Patients were young (34±9yrs), preferentially male (65%) and healthy. Surgery lasted 7±2hr, 2% needed blood transfusion. ICU was offered to 28% of patients. Mean hospital stay was 11.7±5 days with a readmission rate of 2.5%. 10% of patients developed at least one complication, of which 3% were major events (grade 3-5 including one death), mostly related to biliary/bleeding events. Meta-analysis from the 12 centers showed a homogeneous CCI of 22 (95% CI:20-24) in patients developing at least one complication and 28 (27-30) in those developing at least one grade II complication. Minor adverse events were comparable between right and left hemihepatectomies, but major (≥grade3) complications were twice as high in the right hepatectomy group.
CONCLUSIONS:
The thorough outcome analysis including CCIs of healthy living donor may serve as reference for evaluating surgical results in patients with benign and malignant liver tumors. This allows for Benchmarking the performance across centers and different patient populations.



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