Citations 2
Novel Benchmark for Robotic Liver Resection – Bridging Tradition with Innovation
Pfister, Matthias , Ma, Yong , Yang, Guangchao, Li, Linqiang , Song, Xuan , Venezia, Raphael, Jeddou, Heithem , Floc’h, Bastien Le, Valverde, A. , Péru, N. , Pessaux, Patrick, Salloum, Chady , Blanc, P., Scatton, Olivier , Tzedakis, Stylianos , Fuks, David , Chaoui, Ismaël, Silva, Silvia Gomes da, Sobral, M., Centonze, Leonardo , Zhu, Zhu , Ratti, Francesca, Rompianesi, Gianluca , Shah, Jimmy, Wakabayashi, Taiga , Coelho, Fabrício Ferreira , Castillo‐Flores, Samy , Viti, Virginia, Boggi, Ugo , Han, Ho-Seong, Panaro, Fabrizio , Wakabayashi, Go, Ielpo, Benedetto , Mejia, Alejandro , Troisi, Roberto I., Choi, Gi Hong , Liu, Rong , Sucandy, Iswanto, Rela, Mohamed , D’Hondt, Mathieu , Bröering, Dieter C. , Clavien, Pierre‐Alain , Li, Zhihao , Dong, Yawen , Clavien, Pierre-Alain , Centonze, Leonardo , Li, Zhihao , Li, Zhihao, Raptis, Dimitri , Song, Xuan, Millet, Guillaume, Truant, Stéphanie , Venezia, Raphael, Pessaux, Patrick , Giannone, Fabio , Mabrut, Jean‐Yves , Mohkam, Kayvan , Cunha, António Sá , Roy, Bertrand Le , Goumard, Claire , Fuks, David , Rammohan, Ashwin , Silva, Silvia Gomes da, López‐López, Víctor , Ratti, Francesca, Marino, Rebecca , Müller, Philip C , Lee, Bo Ram , Kato, Yutaro , Polanco, Patricio Marcelo , Goh, Brian K P , Cheung, Tan To , Efanov, Mikhail G. , Machado, Marcel Cerqueira César , Herman, Paulo , Müller-Stich, Beat Peter , Starlinger, Patrick , Martinie, John B. , Aldrighetti, Luca , Chen, Guodong , Robles, R , Benedetto, Fabrizio Di , Marques, Hugo P. , Sucandy, Iswanto , Brustia, Raffaele , Soubrane, Olivier
Annals of Surgery | May 20, 2025 | Volume: No volume available | Issue: No issue available | Pages: No page available
Objective: To establish benchmark cutoffs for robotic liver resection (R-LR), encompassing both major and minor resections, and to determine the impact of patient selection on outcomes. Background: R-LR is a key advancement in minimally invasive liver surgery but lacks standardized benchmarks, especially for minor resections. While guidelines endorse R-LR, its role in optimizing outcomes remains unclear. This study establishes the first benchmarks for R-LR, enabling comparisons across surgical modalities and refining patient selection. Methods: This retrospective, multicenter study analyzed consecutive adult patients undergoing R-LR at 30 international centers (2020–2023). Benchmark centers had an annual case volume of ≥15 R-LR. Benchmark criteria included ASA ≤2, no major comorbidities, no prior liver resections, and Child-Pugh A status. Benchmark cutoffs for 14 key outcomes were set at the 50th and 75th percentiles of median values across benchmark centers. Multivariable logistic regression identified predictors of textbook outcomes. Results: Eighteen high-volume centers contributed 4028 cases with 2632 (65.3%) meeting benchmark criteria. Malignancy was the indication in 29.6%, most commonly hepatocellular carcinoma followed by colorectal liver metastases. Major liver resection was performed in 42.6%. The distribution of Iwate difficulty scores was low (25.4%), intermediate (53.9%), advanced (15.9%), and expert (4.9%). Benchmark cutoffs were established for minor and major resection, and stratified by Iwate low (0-3), intermediate (4-6) and high (7-12): Open conversion (≤6.5% minor, ≤10.5% major), major complications within 90 days (≤5.2% minor, ≤16.7% major), R1 resection (≤9.2% minor, ≤6.7% major). Benchmark cases performed at low-volume centers were able to achieve outcomes within the corresponding benchmark cutoffs. In fact, patient selection reflected by the proportion of benchmark patients, rather than case volume, was associated with textbook outcomes. Conclusions: This study defines R-LR benchmarks, emphasizing patient selection over center volume for optimal outcomes. Benchmark cutoffs guide training and support the expansion of R-LR.
Novel Benchmark Values for Open Major Anatomic Liver Resection in Non-cirrhotic Patients
Silva, Richard X. Sousa Da , Breuer, Eva , Shankar, Sadhana , Hołówko, Wacław , Coelho, João Santos, Jeddou, Heithem , Sugiura, Teiichi , Ghallab, Mohammed, Silva, Doris Da, Watanabe, Genki , Sakai, Nozomu , Addeo, Pietro , Tzedakis, Stylianos , Bartsch, F. , Balcer, Kaja, Lim, Chétana , Werey, Fabien, López, Víctor , Montero, Luciana Peralta, Clariá, Rodrigo Sanchez, Leiting, Jennifer L. , Vachharajani, Neeta , Hopping, Eve , Andel, Daan, Hagendoorn, Jeroen , Psica, Alicja , Ahn, Keun Soo , Montes, Leonardo A., Gunasekaran, Ganesh , Alcázar, C. , Lim, Jin Hong , Haroon, Muhammad, Lü, Qian , Castaldi, Antonio , Orimo, Tatsuya , Abadía, Teresa, Hasan, Josefina Dib, Kaufmann, Emmanuele F., Wilde, Roeland F. de , Boggi, Ugo , Hernandez‐Alejandro, Roberto, Serrablo, Alejandro , Taketomi, Akinobu , Dong, Jiahong , Hanif, Faisal, Park, Joon Seong , Schwartz, Myron , Ramisch, Diego , Oliveira, Michelle de , Oldhafer, K.J., Kang, Koo Jeong , Lodge, P., Rinkes, Inne H. M. Borel, Thomson, John‐Edwin , Goh, Su Kah , Chapman, William C. , Pekolj, Juan , Scatton, Olivier , Truant, Stéphanie , Lang, Hauke , Bachellier, Philippe , Otsuka, Masayuki, Popescu, Irinel , Cherqui, Daniel , Uesaka, Katsuhiko , Marques, Hugo P. , Grąt, Michał , Petrowsky, Henrik , Ebata, Tomoki , Prachalias, Andreas , Clavien, Pierre‐Alain , Kauffmann, Emanuele F. , Leiting, Jennifer, Chapman, William C , Shankar, Sadhana , Kawakatsu, Shoji , Botea, Florin , Torres, Orlando Jorge Martins , Hirano, Satoshi , Ravaioli, Matteo , Reese, Tim , Montes, Leonardo A., Castaldi, Antonio, Moeckli, Beat , Ruffolo, Luis I. , Hasan, Josefina Dib, Ratti, Francesca , Polak, Wojciech G. , Aldrighetti, Luca , McCormack, Lucas , Toso, Christian , Gugenheim, Jean , Ramia, José Manuel , Cescon, Matteo , Rinkes, Inne H.M. Borel , Noji, Takehiro , Cleary, Sean P. , Regimbeau, Jean‐Marc , Fuks, David , Hasegawa, Kiyoshi , Lesurtel, Mickaël , Adam, René , Boudjéma, Karim , Robles, R
Annals of Surgery | July 19, 2023 | Volume: 278 | Issue: 5 | Pages: 748-755
Objective: This study aims at establishing benchmark values for best achievable outcomes following open major anatomic hepatectomy for liver tumors of all dignities. Background: Outcomes after open major hepatectomies vary widely lacking reference values for comparisons among centers, indications, types of resections, and minimally invasive procedures. Methods: A standard benchmark methodology was used covering consecutive patients, who underwent open major anatomic hepatectomy from 44 high-volume liver centers from 5 continents over a 5-year period (2016–2020). Benchmark cases were low-risk non-cirrhotic patients without significant comorbidities treated in high-volume centers (≥30 major liver resections/year). Benchmark values were set at the 75th percentile of median values of all centers. Minimum follow-up period was 1 year in each patient. Results: Of 8044 patients, 2908 (36%) qualified as benchmark (low-risk) cases. Benchmark cutoffs for all indications include R0 resection ≥78%; liver failure (grade B/C) ≤10%; bile leak (grade B/C) ≤18%; complications ≥grade 3 and CCI ® ≤46% and ≤9 at 3 months, respectively. Benchmark values differed significantly between malignant and benign conditions so that reference values must be adjusted accordingly. Extended right hepatectomy (H1, 4-8 or H4-8) disclosed a higher cutoff for liver failure, while extended left (H1-5,8 or H2-5,8) were associated with higher cutoffs for bile leaks, but had superior oncologic outcomes, when compared to formal left hepatectomy (H1-4 or H2-4). The minimal follow-up for a conclusive outcome evaluation following open anatomic major resection must be 3 months. Conclusion: These new benchmark cutoffs for open major hepatectomy provide a powerful tool to convincingly evaluate other approaches including parenchymal-sparing procedures, laparoscopic/robotic approaches, and alternative treatments, such as ablation therapy, irradiation, or novel chemotherapy regimens.