Performance evaluation of a North American center using the established global benchmark for laparoscopic liver resections: A retrospective study

Woo Jin Choi, Shiva Babakhani, Marco P.A.W. Claasen, Matthew Castelo, Roxana Bucur, Felipe Gaviria, Owen Jones, Chaya Shwaartz, Stuart A. McCluskey, Ian McGilvray, Steven Gallinger, Carol Anne Moulton, Trevor Reichman, Sean Cleary, Gonzalo Sapisochin*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background: The global benchmark cut-offs were set for laparoscopic liver resection procedures: left lateral sectionectomy, left hepatectomy, and right hepatectomy. We aimed to compare the performance of our North American center with the established global benchmarks. Methods: This is a single-center study of adults who underwent laparoscopic liver resection between 2010 to 2022 at the Toronto General Hospital. Fourteen benchmarking outcomes were assessed: operation time, intraoperative blood transfusion, estimated blood loss, blood loss ≥500 mL, blood loss ≥1000mL, open-conversion, postoperative length of stay, return to operation, postoperative morbidity, postoperative major-morbidity, 30-day mortality, 90-day mortality, R1 resection, and failure to rescue. Low-risk benchmark cases were defined as follows: patients aged 18 to 70 years, American Society of Anesthesiologist score ≤ 2, tumor size <10 cm, and Child–Pugh score ≤A. Cases involving bilio-enteric anastomosis, hilar dissection, or concomitant major procedures were excluded from the low-risk category. Cases that did not meet the criteria for low-risk selection were considered high-risk cases. Results: A total of 178 laparoscopic liver resection cases were analyzed (109 left lateral sectionectomies, 45 left hepatectomies, 24 right hepatectomies). Forty-four (25%) cases qualified as low-risk cases (23 left lateral sectionectomies, 16 left hepatectomies, 5 right hepatectomies). The postoperative major morbidity and 90-day mortality after left lateral sectionectomy, left hepatectomy, and right hepatectomy for the low-risk cases were 0%, 0%, and 0%, and 0%, 0%, and 0%, respectively. For the high-risk cases post-2017, the outcomes in the same order were 0%, 0%, and 12%; 0%, 0%, and 0%, respectively. For the high-risk cases operated pre2017, the outcomes in the same order were 9%∗, 16%∗, and 18%; 2%∗, 0%, and 9%∗ (asterisks indicate not meeting the global cut-off), respectively. Conclusion: A North American center was able to achieve outcomes comparable to the established global benchmark for laparoscopic liver resection.

Original languageEnglish
Pages (from-to)1393-1400
Number of pages8
JournalSurgery (United States)
Volume174
Issue number6
DOIs
StatePublished - Dec 2023
Externally publishedYes

Funding

FundersFunder number
Roche

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