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

Autor:	Famularo S; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Department of Hepatobiliary and General Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; School of Medicine and Surgery, University of Milano-Bicocca, San Gerardo Hospital, Monza, Italy., Russolillo N; Department of General and Oncological Surgery, Mauriziano Hospital 'Umberto I', Turin, Italy., Donadon M; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Department of Hepatobiliary and General Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy. Electronic address: matteo.donadon@hunimed.eu., Cipriani F; Hepatobiliary Surgery Division, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy., Ardito F; Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Catholic University of the Sacred Heart, Rome, Italy., Perri P; Division of Hepatobiliarypancreatic Unit, IRCCS - Regina Elena National Cancer Institute, Rome, Italy., Giani A; School of Medicine and Surgery, University of Milano-Bicocca, San Gerardo Hospital, Monza, Italy., De Stefano F; Unit of General Surgery 1, University of Pavia and Foundation IRCCS Policlinico San Matteo, Pavia, Italy., Lai Q; Hepato-Biliary Surgery and Organ Transplantation Unit, Sapienza University of Rome, Umberto I Polyclinic of Rome, Rome, Italy., Molfino S; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy., Zanello M; Alma Mater Studiorum, University of Bologna, AOU Sant'Orsola Malpighi, IRCCS at Maggiore Hospital, Bologna, Italy., Iaria M; Department of Medicine and Surgery, University of Parma, Parma, Italy., La Barba G; General and Oncologic Surgery, Morgagni-Pierantoni Hospital, Forlì, Italy., Pinotti E; Department of Surgery, Ponte San Pietro Hospital, Bergamo, Italy., Germani P; Surgical Clinics, University Hospital of Trieste, Trieste, Italy., Conci S; Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy., Ferrari C; HPB Surgical Unit, San Paolo Hospital, Savona, Italy., Fumagalli L; Department of Emergency and Robotic Surgery, ASST Lecco, Lecco, Italy., Romano M; Department of Surgical, Oncological and Gastroenterological Science (DISCOG), University of Padua, Hepatobiliary and Pancreatic Surgery Unit - Treviso Hospital, Italy., Antonucci A; Department of Surgery, Monza Policlinic, Monza, Italy., Zimmitti G; Department of General Surgery, Poliambulanza Foundation Hospital, Brescia, Italy., Troci A; Department of Surgery, L. Sacco Hospital, Milan, Italy., Floridi A; Department of General Surgery, ASST Crema, Crema, Italy., Ferraro V; Department of Hepato-Pancreatic-Biliary Surgery, Miulli Hospital, Bari, Italy., Patauner S; Department of General and Pediatric Surgery, Bolzano Central Hospital, Bolzano, Italy., Frena A; Department of General and Pediatric Surgery, Bolzano Central Hospital, Bolzano, Italy., Memeo R; Department of Hepato-Pancreatic-Biliary Surgery, Miulli Hospital, Bari, Italy., Crespi M; Department of Surgery, L. Sacco Hospital, Milan, Italy., Hilal MA; Department of General Surgery, Poliambulanza Foundation Hospital, Brescia, Italy., Zanus G; Department of Surgical, Oncological and Gastroenterological Science (DISCOG), University of Padua, Hepatobiliary and Pancreatic Surgery Unit - Treviso Hospital, Italy., Chiarelli M; Department of Emergency and Robotic Surgery, ASST Lecco, Lecco, Italy., Percivale A; HPB Surgical Unit, San Paolo Hospital, Savona, Italy., Ruzzenente A; Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy., Tarchi P; Surgical Clinics, University Hospital of Trieste, Trieste, Italy., Zago M; Department of Surgery, Ponte San Pietro Hospital, Bergamo, Italy; Department of Emergency and Robotic Surgery, ASST Lecco, Lecco, Italy., Ercolani G; General and Oncologic Surgery, Morgagni-Pierantoni Hospital, Forlì, Italy., Dalla Valle R; Department of Medicine and Surgery, University of Parma, Parma, Italy., Jovine E; Alma Mater Studiorum, University of Bologna, AOU Sant'Orsola Malpighi, IRCCS at Maggiore Hospital, Bologna, Italy., Baiocchi GL; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy., Rossi M; Hepato-Biliary Surgery and Organ Transplantation Unit, Sapienza University of Rome, Umberto I Polyclinic of Rome, Rome, Italy., Maestri M; Unit of General Surgery 1, University of Pavia and Foundation IRCCS Policlinico San Matteo, Pavia, Italy., Romano F; School of Medicine and Surgery, University of Milano-Bicocca, San Gerardo Hospital, Monza, Italy., Grazi GL; Division of Hepatobiliarypancreatic Unit, IRCCS - Regina Elena National Cancer Institute, Rome, Italy., Giuliante F; Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Catholic University of the Sacred Heart, Rome, Italy., Aldrighetti L; Hepatobiliary Surgery Division, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy., Ferrero A; Department of General and Oncological Surgery, Mauriziano Hospital 'Umberto I', Turin, Italy., Torzilli G; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Department of Hepatobiliary and General Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
Jazyk:	angličtina
Zdroj:	HPB : the official journal of the International Hepato Pancreato Biliary Association [HPB (Oxford)] 2022 Aug; Vol. 24 (8), pp. 1365-1375. Date of Electronic Publication: 2022 Mar 01.
DOI:	10.1016/j.hpb.2022.02.008
Abstrakt:	Background: Benchmark analysis for open liver surgery for cirrhotic patients with hepatocellular carcinoma (HCC) is still undefined. Methods: Patients 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). Results: A 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). Conclusion: We 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. (Copyright © 2022 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.)
Databáze:	MEDLINE
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