Sho Ibuki1,2, Taizo Hibi2, Minoru Tanabe3, David A Geller4, Daniel Cherqui5, Go Wakabayashi6. 1. Department of Surgery, Keio University School of Medicine, Tokyo, Japan. 2. Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan. 3. Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan. 4. Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, UPMC Liver Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. 5. ΑΡ-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France and Université Paris-Sud, Faculte de Medecine, Le Kremlin-Bicêtre, France. 6. Department of Surgery, Ageo Central General Hospital, Ageo, Japan.
Abstract
OBJECTIVE: To define the current status of "difficult" LLR, a global database was created and investigated. BACKGROUND: In the Second International Consensus Conference in 2014, minor LLR was considered as a standard practice and major LLR remained an innovative procedure. Since then, no updates on worldwide trends have been available. METHODS: A questionnaire on all consecutive patients who underwent difficult LLR (major hepatectomy, posterosuperior segmentectomy, sectionec-tomy, living donor hepatectomy, tumor size ≥10 cm, Child-Pugh grade ≥B, combined with biliary reconstruction, and Iwate criteria difficulty score ≥7) in 2014-2018 was distributed via email to 65 high-volume LLR centers worldwide. individual data on patient and tumor demographics, surgical information, and short-term outcomes were obtained to create a large-scale international registry for analyses. RESULTS: Overall, 58 centers in 19 countries performed 4478 difficult LLR (median, 58.5; range, 5-418) during the study period. Hepatocellular carcinoma accounted for ≥ 40% of all indications. Half of the patients underwent major hepatectomy, followed by sectionectomy, posterosuperior segmentectomy, and living donor hepatectomy. in the vast majority of procedures, Clavien-Dindo grade ≥IIIa complication rates of ≈10% and 90-day mortality rates of ≈1% were achieved. Left or right trisectionectomy had the worst Clavien-Dindo grade ≥IIIa complication rate of ≥10% and 90-day mortality rate of 5%-10%. No significant correlation was observed between center volume and short-term outcomes. CONCLUSIONS: Total 4478 patients underwent difficult LLR worldwide in 2014-2018. Most procedures are safe and feasible when conducted in specialized centers.
OBJECTIVE: To define the current status of "difficult" LLR, a global database was created and investigated. BACKGROUND: In the Second International Consensus Conference in 2014, minor LLR was considered as a standard practice and major LLR remained an innovative procedure. Since then, no updates on worldwide trends have been available. METHODS: A questionnaire on all consecutive patients who underwent difficult LLR (major hepatectomy, posterosuperior segmentectomy, sectionec-tomy, living donor hepatectomy, tumor size ≥10 cm, Child-Pugh grade ≥B, combined with biliary reconstruction, and Iwate criteria difficulty score ≥7) in 2014-2018 was distributed via email to 65 high-volume LLR centers worldwide. individual data on patient and tumor demographics, surgical information, and short-term outcomes were obtained to create a large-scale international registry for analyses. RESULTS: Overall, 58 centers in 19 countries performed 4478 difficult LLR (median, 58.5; range, 5-418) during the study period. Hepatocellular carcinoma accounted for ≥ 40% of all indications. Half of the patients underwent major hepatectomy, followed by sectionectomy, posterosuperior segmentectomy, and living donor hepatectomy. in the vast majority of procedures, Clavien-Dindo grade ≥IIIa complication rates of ≈10% and 90-day mortality rates of ≈1% were achieved. Left or right trisectionectomy had the worst Clavien-Dindo grade ≥IIIa complication rate of ≥10% and 90-day mortality rate of 5%-10%. No significant correlation was observed between center volume and short-term outcomes. CONCLUSIONS: Total 4478 patients underwent difficult LLR worldwide in 2014-2018. Most procedures are safe and feasible when conducted in specialized centers.
Authors: Yang Jinhuan; Wang Yi; Zheng Yuanwen; Ma Delin; Chen Xiaotian; Wang Yan; Deng Liming; Yu Haitao; Wu Lijun; Deng Tuo; Chen Kaiyu; Hu Jiawei; Zheng Chongming; Wang Daojie; Jin Bin; Chen Gang Journal: Front Oncol Date: 2022-01-07 Impact factor: 6.244