Defining Benchmarks for Major Liver Surgery

作者：Fabian Rössler, Gonzalo Sapisochín, Gi‐Won Song, Yu‐Hung Lin, Mary Ann Simpson, Kiyoshi Hasegawa, Andrea Laurenzi, Santiago Sánchez-Cabús, Milton Inostroza Nunez, Andrea Gatti, M. Chahdi Beltrame, Ksenija Slankamenac, Paul D. Greig, Sung‐Gyu Lee, Chao‐Long Chen, David Grant, Elizabeth A. Pomfret, Norihiro Kokudo, Daniel Cherqui, Kim M. Olthoff, Abraham Shaked, Juan Carlos García‐Valdecasas, Jan Lerut, Roberto Troisi, Martín de Santibañes, Henrik Petrowsky, Milo A. Puhan, Pierre-Alain Clavien · 发表于：Annals of Surgery · 年份：2016 · DOI：10.1097/sla.0000000000001849 · 被引用次数：224 · 研究领域：Hepatocellular Carcinoma Treatment and Prognosis、Organ Transplantation Techniques and Outcomes、Liver Disease and Transplantation

OBJECTIVE: To measure and define the best achievable outcome after major hepatectomy. BACKGROUND: No reference values are available on outcomes after major hepatectomies. Analysis in living liver donors, with safety as the highest priority, offers the opportunity to define outcome benchmarks as the best possible results. METHODS: Outcome analyses of 5202 hemi-hepatectomies from living donors (LDs) from 12 high-volume centers worldwide were performed for a 10-year period. Endpoints, calculated at discharge, 3 and 6 months postoperatively, included postoperative morbidity measured by the Clavien-Dindo classification, the Comprehensive Complication Index (CCI), and liver failure according to different definitions. Benchmark values were defined as the 75th percentile of median morbidity values to represent the best achievable results at 3 month postoperatively. RESULTS: Patients were young (34 ± [9] years), predominantly male (65%) and healthy. Surgery lasted 7 ± [2] hours; 2% needed blood transfusions. Mean hospital stay was 11.7± [5] days. 12% of patients developed at least 1 complication, of which 3.8% were major events (≥grade III, including 1 death), mostly related to biliary/bleeding events, and were twice higher after right hepatectomy. The incidence of postoperative liver failure was low. Within 3-month follow-up, benchmark values for overall complication were ≤31 %, for minor/major complications ≤23% and ≤9%, respectively, and a CCI ≤33 in LDs with complications. Centers...