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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 5/2024

Open Access 12-01-2024 | Liver Resection | Hepatobiliary Tumors

Benchmarks in Liver Resection for Intrahepatic Cholangiocarcinoma

Authors: Laura Alaimo, MD, Yutaka Endo, MD, Giovanni Catalano, MD, Andrea Ruzzenente, MD, Luca Aldrighetti, MD, Matthew Weiss, MD, Todd W. Bauer, MD, Sorin Alexandrescu, MD, George A. Poultsides, MD, Shishir K. Maithel, MD, Hugo P. Marques, MD, Guillaume Martel, MD, Carlo Pulitano, MD, Feng Shen, MD, François Cauchy, MD, Bas Groot Koerkamp, MD, Itaru Endo, MD, Minoru Kitago, MD, Timothy M. Pawlik, MD, PhD, MPH, MTS, MBA, FACS, FRACS (Hon.)

Published in: Annals of Surgical Oncology | Issue 5/2024

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Abstract

Introduction

Benchmarking in surgery has been proposed as a means to compare results across institutions to establish best practices. We sought to define benchmark values for hepatectomy for intrahepatic cholangiocarcinoma (ICC) across an international population.

Methods

Patients who underwent liver resection for ICC between 1990 and 2020 were identified from an international database, including 14 Eastern and Western institutions. Patients operated on at high-volume centers who had no preoperative jaundice, ASA class <3, body mass index <35 km/m2, without need for bile duct or vascular resection were chosen as the benchmark group.

Results

Among 1193 patients who underwent curative-intent hepatectomy for ICC, 600 (50.3%) were included in the benchmark group. Among benchmark patients, median age was 58.0 years (interquartile range [IQR] 49.0–67.0), only 28 (4.7%) patients received neoadjuvant therapy, and most patients had a minor resection (n = 499, 83.2%). Benchmark values included ≥3 lymph nodes retrieved when lymphadenectomy was performed, blood loss ≤600 mL, perioperative blood transfusion rate ≤42.9%, and operative time ≤339 min. The postoperative benchmark values included TOO achievement ≥59.3%, positive resection margin ≤27.5%, 30-day readmission ≤3.6%, Clavien-Dindo III or more complications ≤14.3%, and 90-day mortality ≤4.8%, as well as hospital stay ≤14 days.

Conclusions

Benchmark cutoffs targeting short-term perioperative outcomes can help to facilitate comparisons across hospitals performing liver resection for ICC, assess inter-institutional variation, and identify the highest-performing centers to improve surgical and oncologic outcomes.
Appendix
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Metadata
Title
Benchmarks in Liver Resection for Intrahepatic Cholangiocarcinoma
Authors
Laura Alaimo, MD
Yutaka Endo, MD
Giovanni Catalano, MD
Andrea Ruzzenente, MD
Luca Aldrighetti, MD
Matthew Weiss, MD
Todd W. Bauer, MD
Sorin Alexandrescu, MD
George A. Poultsides, MD
Shishir K. Maithel, MD
Hugo P. Marques, MD
Guillaume Martel, MD
Carlo Pulitano, MD
Feng Shen, MD
François Cauchy, MD
Bas Groot Koerkamp, MD
Itaru Endo, MD
Minoru Kitago, MD
Timothy M. Pawlik, MD, PhD, MPH, MTS, MBA, FACS, FRACS (Hon.)
Publication date
12-01-2024
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 5/2024
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-023-14880-8

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