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Benchmarking postoperative outcomes after open liver surgery for cirrhotic patients with hepatocellular carcinoma in a national cohort

2022; Elsevier BV; Volume: 24; Issue: 8 Linguagem: Inglês

10.1016/j.hpb.2022.02.008

1477-2574

Simone Famularo, Nadia Russolillo, Matteo Donadon, Federica Cipriani, Francesco Ardito, Pasquale Perri, Alessandro Giani, Francesca De Stefano, Quirino Lai, Sarah Molfino, Matteo Zanello, Maurizio Iaria, Giuliano La Barba, Enrico Pinotti, Paola Germani, Simone Conci, Cecilia Ferrari, Luca Fumagalli, Maurizio Romano, Adelmo Antonucci, Giuseppe Zimmitti, Albert Troci, Antonio Floridi, Valentina Ferraro, Stefan Patauner, Antonio Frena, Riccardo Memeo, Michele Crespi, Mohammad Abu Hilal, Giacomo Zanus, Marco Chiarelli, Andrea Percivale, Andrea Ruzzenente, Paola Tarchi, Mauro Zago, Giorgio Ercolani, Raffaele Dalla Valle, Elio Jovine, Gian Luca Baiocchi, Massimo Rossi, Marcello Maestri, Fabrizio Romano, Gian Luca Grazi, Felice Giuliante, Luca Aldrighetti, Alessandro Ferrero, Guido Torzilli, Guido Costa, Flavio Milana, Federico Fazio, Francesca Ratti, Francesco Razionale, Valerio De Peppo, Francesca Carissimi, Giorgio Maria Paolo Graziano, Zoe Larghi Laureiro, Mario Giuffrida, Alessandro Cucchetti, Mauro Montuori, Davide Cosola, Pio Corleone, Giovanni Lazzari, Angelo Franceschi, Pietro Calcagno, Luca Salvador, Alberto Manzoni, Luca Pennacchi, Annarita Libia, Francesca Notte, Davide Paolo Bernasconi, Silvia Mori, Davide Gaudesi,

Liver Disease and Transplantation

BackgroundBenchmark analysis for open liver surgery for cirrhotic patients with hepatocellular carcinoma (HCC) is still undefined.MethodsPatients were identified from the Italian national registry HE.RC.O.LE.S. The Achievable Benchmark of Care (ABC) method was employed to identify the benchmarks. The outcomes assessed were the rate of complications, major comorbidities, post-operative ascites (POA), post-hepatectomy liver failure (PHLF), 90-day mortality. Benchmarking was stratified for surgical complexity (CP1, CP2 and CP3).ResultsA total of 978 of 2698 patients fulfilled the inclusion criteria. 431 (44.1%) patients were treated with CP1 procedures, 239 (24.4%) with CP2 and 308 (31.5%) with CP3 procedures. Patients submitted to CP1 had a worse underlying liver function, while the tumor burden was more severe in CP3 cases. The ABC for complications (13.1%, 19.2% and 28.1% for CP1, CP2 and CP3 respectively), major complications (7.6%, 11.1%, 12.5%) and 90-day mortality (0%, 3.3%, 3.6%) increased with the surgical difficulty, but not POA (4.4%, 3.3% and 2.6% respectively) and PHLF (0% for all groups).ConclusionWe propose benchmarks for open liver resections in HCC cirrhotic patients, stratified for surgical complexity. The difference between the benchmark values and the results obtained during everyday practice reflects the room for potential growth, with the aim to encourage constant improvement among liver surgeons.