Matteo Mueller1, Eva Breuer1, Takashi Mizuno2, Fabian Bartsch3, Francesca Ratti4, Christian Benzing5, Noémie Ammar-Khodja6, Teiichi Sugiura7, Tsukasa Takayashiki8, Amelia Hessheimer9, Hyung Sun Kim10, Andrea Ruzzenente11, Keun Soo Ahn12, Tiffany Wong13, Jan Bednarsch14, Mizelle D'Silva15, Bas Groot Koerkamp16, Heithem Jeddou17, Victor López-López18, Charles de Ponthaud19, Jennifer A Yonkus20, Warsan Ismail21, Lynn E Nooijen22, Camila Hidalgo-Salinas23, Elissaios Kontis24, Kim C Wagner25, Ganesh Gunasekaran26, Ryota Higuchi27, Ana Gleisner28, Chaya Shwaartz29, Gonzalo Sapisochin29, Richard D Schulick28, Masakazu Yamamoto27, Takehiro Noji30, Satoshi Hirano30, Myron Schwartz26, Karl J Oldhafer25, Andreas Prachalias24, Giuseppe K Fusai23, Joris I Erdmann22, Pål-Dag Line31, Rory L Smoot20, Olivier Soubrane19, Ricardo Robles-Campos18, Karim Boudjema17, Wojciech G Polak16, Ho-Seong Han15, Ulf P Neumann14, Chung-Mau Lo13, Koo Jeong Kang12, Alfredo Guglielmi11, Joon Seong Park10, Constantino Fondevila9, Masayuki Ohtsuka8, Katsuhiko Uesaka7, René Adam6, Johann Pratschke5, Luca Aldrighetti4, Michelle L De Oliveira1, Gregory J Gores32, Hauke Lang3, Masato Nagino2, Pierre-Alain Clavien1. 1. Department of Surgery and Transplantation, Swiss HPB Center, University Hospital Zurich, Switzerland. 2. Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan. 3. Department of General, Visceral and Transplantation Surgery, University Medical Center, Mainz, Germany. 4. Division of Hepatobiliary Surgery, IRCCS San Raffaele Hospital, Vita - Salute University, Milan, Italy. 5. Department of Surgery, Charité-Universitätsmedizin, Berlin, Germany. 6. The Centre Hépato-Biliaire, Hôpital Paul Brousse, Villejuif, France. 7. Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan. 8. Department of General Surgery, Chiba University Graduate School of Medicine, Chiba, Japan. 9. General and Digestive Surgery Department, Hospital Clínic, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain. 10. Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. 11. Unit of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy. 12. Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, School of Medicine, Keimyung University, Dongsan Hospital, Daegu, Republic of Korea. 13. Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China. 14. Department of General, Gastrointestinal, Hepatobiliary and Transplant Surgery, RWTH Aachen University Hospital, Aachen, Germany. 15. Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea. 16. Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands. 17. Service de Chirurgie Hépatobiliaire et Digestive, CHU Rennes, Univ Rennes, Rennes, France. 18. Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de la Arrixaca, Murcia, Spain. 19. Department of HPB And Pancreatic surgery, Beaujon University Hospital, Clichy, France. 20. Division of Hepatobiliary and Pancreatic Surgery, Mayo Clinic, Rochester, MN. 21. Department of Hepatobiliary and Pancreatic Surgery, Oslo University Hospital, Oslo, Norway. 22. Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, The Netherlands. 23. Department of HPB and Liver Transplant Surgery, Royal Free Hospital, London, United Kingdom. 24. Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, United Kingdom. 25. Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, Asklepios Hospital Barmbek, Semmelweis University Budapest, Faculty of Medicine, Asklepios Campus Hamburg, Hamburg, Germany. 26. Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY. 27. Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan. 28. Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO. 29. Multi-Organ Transplant and HPB Surgical Oncology, Division of General Surgery, University Health Network, Department of Surgery, University of Toronto, Toronto, Ontario, Canada. 30. Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Sapporo, Japan. 31. Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway. 32. Division of Gastroenterology & Hepatology, Mayo Clinic, Rochester, MN.
Abstract
OBJECTIVE: The aim of this study was to define robust benchmark values for the surgical treatment of perihilar cholangiocarcinomas (PHC) to enable unbiased comparisons. BACKGROUND: Despite ongoing efforts, postoperative mortality and morbidity remains high after complex liver surgery for PHC. Benchmark data of best achievable results in surgical PHC treatment are however still lacking. METHODS: This study analyzed consecutive patients undergoing major liver surgery for PHC in 24 high-volume centers in 3 continents over the recent 5-year period (2014-2018) with a minimum follow-up of 1 year in each patient. Benchmark patients were those operated at high-volume centers (≥50 cases during the study period) without the need for vascular reconstruction due to tumor invasion, or the presence of significant co-morbidities such as severe obesity (body mass index ≥35), diabetes, or cardiovascular diseases. Benchmark cutoff values were derived from the 75th or 25th percentile of the median values of all benchmark centers. RESULTS: Seven hundred eight (39%) of a total of 1829 consecutive patients qualified as benchmark cases. Benchmark cut-offs included: R0 resection ≥57%, postoperative liver failure (International Study Group of Liver Surgery): ≤35%; in-hospital and 3-month mortality rates ≤8% and ≤13%, respectively; 3-month grade 3 complications and the CCI: ≤70% and ≤30.5, respectively; bile leak-rate: ≤47% and 5-year overall survival of ≥39.7%. Centers operating mostly on complex cases disclosed better outcome including lower post-operative liver failure rates (4% vs 13%; P = 0.002). Centers from Asia disclosed better outcomes. CONCLUSION: Surgery for PHC remains associated with high morbidity and mortality with now the availability of benchmark values covering 21 outcome parameters, which may serve as key references for comparison in any future analyses of individuals, group of patients or centers.
OBJECTIVE: The aim of this study was to define robust benchmark values for the surgical treatment of perihilar cholangiocarcinomas (PHC) to enable unbiased comparisons. BACKGROUND: Despite ongoing efforts, postoperative mortality and morbidity remains high after complex liver surgery for PHC. Benchmark data of best achievable results in surgical PHC treatment are however still lacking. METHODS: This study analyzed consecutive patients undergoing major liver surgery for PHC in 24 high-volume centers in 3 continents over the recent 5-year period (2014-2018) with a minimum follow-up of 1 year in each patient. Benchmark patients were those operated at high-volume centers (≥50 cases during the study period) without the need for vascular reconstruction due to tumor invasion, or the presence of significant co-morbidities such as severe obesity (body mass index ≥35), diabetes, or cardiovascular diseases. Benchmark cutoff values were derived from the 75th or 25th percentile of the median values of all benchmark centers. RESULTS: Seven hundred eight (39%) of a total of 1829 consecutive patients qualified as benchmark cases. Benchmark cut-offs included: R0 resection ≥57%, postoperative liver failure (International Study Group of Liver Surgery): ≤35%; in-hospital and 3-month mortality rates ≤8% and ≤13%, respectively; 3-month grade 3 complications and the CCI: ≤70% and ≤30.5, respectively; bile leak-rate: ≤47% and 5-year overall survival of ≥39.7%. Centers operating mostly on complex cases disclosed better outcome including lower post-operative liver failure rates (4% vs 13%; P = 0.002). Centers from Asia disclosed better outcomes. CONCLUSION: Surgery for PHC remains associated with high morbidity and mortality with now the availability of benchmark values covering 21 outcome parameters, which may serve as key references for comparison in any future analyses of individuals, group of patients or centers.
Authors: Mohamedraed Elshami; Jonathan J Hue; Fasih Ali Ahmed; Hanna Kakish; Richard S Hoehn; Luke D Rothermel; Jeffrey M Hardacre; John B Ammori; Jordan M Winter; Lee M Ocuin Journal: J Gastrointest Surg Date: 2022-09-22 Impact factor: 3.267
Authors: Giammauro Berardi; Marco Colasanti; Roberto Luca Meniconi; Stefano Ferretti; Nicola Guglielmo; Germano Mariano; Mirco Burocchi; Alessandra Campanelli; Andrea Scotti; Alessandra Pecoraro; Marco Angrisani; Paolo Ferrari; Andrea Minervini; Camilla Gasparoli; Go Wakabayashi; Giuseppe Maria Ettorre Journal: Diagnostics (Basel) Date: 2021-11-23