Defining Global Benchmarks for Laparoscopic Liver Resections
Brian K. P. Goh, Ho‐Seong Han, Kuo-Hsin Chen, Darren W. Chua, Chung Yip Chan, Federica Cipriani, Davit L. Aghayan, Åsmund Avdem Fretland, Jasper P. Sijberden, Mizelle D’Silva, Tiing-Foong Siow, Yutaro Kato, Chétana Lim, Phan Phuoc Nghia, Paulo Herman, Marco V. Marino, Vincenzo Mazzaferro, Adrian Kah Heng Chiow, Iswanto Sucandy, Arpad Ivanecz, Sung Hoon Choi, Jae Hoon Lee, Mikel Gastaca, Marco Vivarelli, Felice Giuliante, Andrea Ruzzenente, Chee-Chien Yong, Mengqui Yin, Zewei Chen, Constantino Fondevila, Михаил Ефанов, Fernando Rotellar, Gi Hong Choi, Ricardo Robless Campos, Xiaoying Wang, Robert P. Sutcliffe, Johann Pratschke, Eric C. H. Lai, Charing C. N. Chong, Mathieu D’Hondt, Kazuteru Monden, Santiago López‐Ben, Fabrício Ferreira Coelho, Thomas Peter Kingham, Rong Liu, Tran Cong Duy Long, Alessandro Ferrero, Giovanni Battista Levi Sandri, Mansour Saleh, Daniel Cherqui, Olivier Scatton, Olivier Soubrane, Go Wakabayashi, Roberto Troisi, Tan To Cheung, Atsushi Sugioka, Mohammad Abu Hilal, David Fuks, Bjørn Edwin, Luca Aldrighetti, International Robotic and Laparoscopic Liver Resection Study Group Investigators
Abstract
OBJECTIVE: To establish global benchmark outcomes indicators after laparoscopic liver resections (L-LR). BACKGROUND: There is limited published data to date on the best achievable outcomes after L-LR. METHODS: This is a post hoc analysis of a multicenter database of 11,983 patients undergoing L-LR in 45 international centers in 4 continents between 2015 and 2020. Three specific procedures: left lateral sectionectomy (LLS), left hepatectomy (LH), and right hepatectomy (RH) were selected to represent the 3 difficulty levels of L-LR. Fifteen outcome indicators were selected to establish benchmark cutoffs. RESULTS: There were 3519 L-LR (LLS, LH, RH) of which 1258 L-LR (40.6%) cases performed in 34 benchmark expert centers qualified as low-risk benchmark cases. These included 659 LLS (52.4%), 306 LH (24.3%), and 293 RH (23.3%). The benchmark outcomes established for operation time, open conversion rate, blood loss ≥500 mL, blood transfusion rate, postoperative morbidity, major morbidity, and 90-day mortality after LLS, LH, and RH were 209.5, 302, and 426 minutes; 2.1%, 13.4%, and 13.0%; 3.2%, 20%, and 47.1%; 0%, 7.1%, and 10.5%; 11.1%, 20%, and 50%; 0%, 7.1%, and 20%; and 0%, 0%, and 0%, respectively. CONCLUSIONS: This study established the first global benchmark outcomes for L-LR in a large-scale international patient cohort. It provides an up-to-date reference regarding the "best achievable" results for L-LR for which centers adopting L-LR can use as a comparison to enable an objective assessment of performance gaps and learning curves.