Diamantis I Tsilimigras1, Kota Sahara1, Dimitrios Moris1, Rittal Mehta1, Anghela Z Paredes1, Francesca Ratti2, Hugo P Marques3, Olivier Soubrane4, Vincent Lam5, George A Poultsides6, Irinel Popescu7, Sorin Alexandrescu7, Guillaume Martel8, Aklile Workneh8, Alfredo Guglielmi9, Tom Hugh10, Luca Aldrighetti2, Matthew Weiss11, Todd W Bauer12, Shishir K Maithel13, Carlo Pulitano14, Feng Shen15, Bas Groot Koerkamp16, Itaru Endo17, Timothy M Pawlik18,19. 1. Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA. 2. Department of Surgery, Ospedale San Raffaele, Milan, Italy. 3. Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal. 4. Department of Hepatobiliopancreatic Surgery, AP-HP, Beaujon Hospital, Clichy, France. 5. Department of Surgery, Westmead Hospital, Sydney, NSW, Australia. 6. Department of Surgery, Stanford University, Stanford, CA, USA. 7. Department of Surgery, Fundeni Clinical Institute, Bucharest, Romania. 8. Department of Surgery, University of Ottawa, Ottawa, ON, Canada. 9. Department of Surgery, University of Verona, Verona, Italy. 10. Department of Surgery, The University of Sydney, Sydney, NSW, Australia. 11. Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA. 12. Department of Surgery, University of Virginia, Charlottesville, VA, USA. 13. Department of Surgery, Emory University, Atlanta, GA, USA. 14. Department of Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia. 15. Department of Surgery, Eastern Hepatobiliary Surgery Hospital, Shanghai, China. 16. Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands. 17. Department of Gastroenterological Surgery, Yokohama City University School of Medicine, Yokohama, Japan. 18. Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA. tim.pawlik@osumc.edu. 19. Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University, Wexner Medical Center, Columbus, OH, USA. tim.pawlik@osumc.edu.
Abstract
INTRODUCTION: The objective of the current study was to comprehensively assess the change of practice in hepatobiliary surgery by determining the rates and the trends of textbook outcomes (TO) among patients undergoing surgery for primary liver cancer over time. METHODS: Patients undergoing curative-intent resection for primary liver malignancies, including hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) between 2005 and 2017 were analyzed using a large, international multi-institutional dataset. Rates of TO were assessed over time. Factors associated with achieving a TO and the impact of TO on long-term survival were examined. RESULTS: Among 1829 patients, 944 (51.6%) and 885 (48.4%) individuals underwent curative-intent resection for HCC and ICC, respectively. Over time, patients were older, more frequently had ASA class > 2, albumin-bilirubin grade 2/3, major vascular invasion and more frequently underwent major liver resection (all p < 0.05). Overall, a total of 1126 (62.0%) patients achieved a TO. No increasing trends in TO rates were noted over the years (ptrend = 0.90). In addition, there was no increasing trend in the TO rates among patients undergoing either major (ptrend = 0.39) or minor liver resection (ptrend = 0.63) over the study period. Achieving a TO was independently associated with 26% and 37% decreased hazards of death among ICC (HR 0.74, 95%CI 0.56-0.97) and HCC patients (HR 0.63, 95%CI 0.46-0.85), respectively. CONCLUSION: Approximately 6 in 10 patients undergoing surgery for primary liver tumors achieved a TO. While TO rates did not increase over time, TO was associated with better long-term outcomes following liver resection for both HCC and ICC.
INTRODUCTION: The objective of the current study was to comprehensively assess the change of practice in hepatobiliary surgery by determining the rates and the trends of textbook outcomes (TO) among patients undergoing surgery for primary liver cancer over time. METHODS:Patients undergoing curative-intent resection for primary liver malignancies, including hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) between 2005 and 2017 were analyzed using a large, international multi-institutional dataset. Rates of TO were assessed over time. Factors associated with achieving a TO and the impact of TO on long-term survival were examined. RESULTS: Among 1829 patients, 944 (51.6%) and 885 (48.4%) individuals underwent curative-intent resection for HCC and ICC, respectively. Over time, patients were older, more frequently had ASA class > 2, albumin-bilirubin grade 2/3, major vascular invasion and more frequently underwent major liver resection (all p < 0.05). Overall, a total of 1126 (62.0%) patients achieved a TO. No increasing trends in TO rates were noted over the years (ptrend = 0.90). In addition, there was no increasing trend in the TO rates among patients undergoing either major (ptrend = 0.39) or minor liver resection (ptrend = 0.63) over the study period. Achieving a TO was independently associated with 26% and 37% decreased hazards of death among ICC (HR 0.74, 95%CI 0.56-0.97) and HCC patients (HR 0.63, 95%CI 0.46-0.85), respectively. CONCLUSION: Approximately 6 in 10 patients undergoing surgery for primary liver tumors achieved a TO. While TO rates did not increase over time, TO was associated with better long-term outcomes following liver resection for both HCC and ICC.
Authors: J Madison Hyer; Joal D Beane; Gaya Spolverato; Diamantis I Tsilimigras; Adrian Diaz; Alessandro Paro; Djhenne Dalmacy; Timothy M Pawlik Journal: J Gastrointest Surg Date: 2021-09-10 Impact factor: 3.452
Authors: Daniel Aliseda; Pablo Martí-Cruchaga; Gabriel Zozaya; Alberto Benito; Luis Lopez-Olaondo; Macarena Rodríguez-Fraile; José I Bilbao; Francisco Hidalgo; Mercedes Iñarrairaegui; Rubén Ciria; Fernando Pardo; Bruno Sangro; Fernando Rotellar Journal: Langenbecks Arch Surg Date: 2022-02-28 Impact factor: 2.895