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

被引：11

作者：

Famularo, Simone ^{[1
,2
,3
]}

Russolillo, Nadia ^{[4
]}

Donadon, Matteo ^{[1
,2
]}

Cipriani, Federica ^{[5
]}

Ardito, Francesco ^{[6
]}

Perri, Pasquale ^{[7
]}

Giani, Alessandro ^{[3
]}

De Stefano, Francesca ^{[8
,9
]}

Lai, Quirino ^{[10
]}

Molfino, Sarah ^{[11
]}

Zanello, Matteo ^{[12
]}

Iaria, Maurizio ^{[13
]}

La Barba, Giuliano ^{[14
]}

Pinotti, Enrico ^{[15
]}

Germani, Paola ^{[16
]}

Conci, Simone ^{[17
]}

Ferrari, Cecilia ^{[18
]}

Fumagalli, Luca ^{[19
]}

Romano, Maurizio ^{[20
]}

Antonucci, Adelmo ^{[21
]}

Zimmitti, Giuseppe ^{[22
]}

Troci, Albert ^{[23
]}

Floridi, Antonio ^{[24
]}

Ferraro, Valentina ^{[25
]}

Patauner, Stefan ^{[26
]}

Frena, Antonio ^{[26
]}

Memeo, Riccardo ^{[25
]}

Crespi, Michele ^{[23
]}

Hilal, Mohammed A. ^{[22
]}

Zanus, Giacomo ^{[20
]}

Chiarelli, Marco ^{[19
]}

Percivale, Andrea ^{[18
]}

Ruzzenente, Andrea ^{[17
]}

Tarchi, Paola ^{[16
]}

Zago, Mauro ^{[15
,19
]}

Ercolani, Giorgio ^{[14
]}

Dalla Valle, Raffaele ^{[13
]}

Jovine, Elio ^{[12
]}

Baiocchi, Gian Luca ^{[11
]}

Rossi, Massimo ^{[10
]}

Maestri, Marcello ^{[8
,9
]}

Romano, Fabrizio ^{[3
]}

Grazi, Gian Luca ^{[7
]}

Giuliante, Felice ^{[6
]}

Aldrighetti, Luca ^{[5
]}

Ferrero, Alessandro ^{[4
]}

Torzilli, Guido ^{[1
,2
]}

机构：

[1] Humanitas Univ, Dept Biomed Sci, Pieve Emanuele, Italy

[2] IRCCS Humanitas Res Hosp, Dept Hepatobiliary & Gen Surg, Milan, Italy

[3] Univ Milano Bicocca, San Gerardo Hosp, Sch Med & Surg, Monza, Italy

[4] Mauriziano Hosp Umberto I, Dept Gen & Oncol Surg, Turin, Italy

[5] Univ Vita Salute San Raffaele, IRCCS San Raffaele Sci Inst, Hepatobiliary Surg Div, Milan, Italy

[6] Univ Cattolica Sacro Cuore, Fdn Policlin Univ A Gemelli, Hepatobiliary Surg Unit, IRCCS, Rome, Italy

[7] IRCCS Regina Elena Natl Canc Inst, Div Hepatobiliarypancreat Unit, Rome, Italy

[8] Univ Pavia, Unit Gen Surg 1, Pavia, Italy

[9] Fdn IRCCS Policlin San Matteo, Pavia, Italy

[10] Sapienza Univ Rome, Umberto I Polyclin Rome, Hepatobiliary Surg & Organ Transplantat Unit, Rome, Italy

[11] Univ Brescia, Dept Clin & Expt Sci, Brescia, Italy

[12] Univ Bologna, IRCCS Maggiore Hosp, AOU St Orsola Malpighi, Alma Mater Studiorum, Bologna, Italy

[13] Univ Parma, Dept Med & Surg, Parma, Italy

[14] Morgagni Pierantoni Hosp, Gen & Oncol Surg, Forli, Italy

[15] Ponte San Pietro Hosp, Dept Surg, Bergamo, Italy

[16] Univ Hosp Trieste, Surg Clin, Trieste, Italy

[17] Univ Verona, Div Gen & Hepatobiliary Surg, Dept Surg Sci Dent Gynecol & Pediat, Verona, Italy

[18] San Paolo Hosp, HPB Surg Unit, Savona, Italy

[19] ASST Lecco, Dept Emergency & Robot Surg, Lecce, Italy

[20] Univ Padua, Dept Surg Oncol & Gastroenterol Sci DISCOG, Hepatobiliary & Pancreat Surg Unit, Treviso Hosp, Padua, Italy

[21] Monza Policlin, Dept Surg, Monza, Italy

[22] Poliambulanza Fdn Hosp, Dept Gen Surg, Brescia, Italy

[23] L Sacco Hosp Vialba, Dept Surg, Milan, Italy

[24] ASST Crema, Dept Gen Surg, Crema, Italy

[25] Miulli Hosp, Dept Hepatopancreat Biliary Surg, Bari, Italy

[26] Bolzano Cent Hosp, Dept Gen & Pediat Surg, Bolzano, Italy

来源：

HPB | 2022年 / 24卷 / 08期

关键词：

DEFINING BENCHMARKS; ESTABLISHING BENCHMARKS; CARE; COMPLICATIONS; CRITERIA; FAILURE; IMPACT;

D O I：

10.1016/j.hpb.2022.02.008

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

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.

引用

页码：1365 / 1375

页数：11

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