Assessing Textbook Outcomes Following Liver Surgery for Primary Liver Cancer Over a 12-Year Time Period at Major Hepatobiliary Centers

Tsilimigras, Diamantis I.; Sahara, Kota; Moris, Demetrios; Mehta, Rittal; Paredes, Anghela Z.; Ratti, Francesca; Marques, Hugo P.; Soubrane, Olivier; Lam, Vincent; Poultsides, George A.; Popescu, Irinel; Alexandrescu, Sorin; Martel, Guillaume; Workneh, Aklile; Guglielmi, Alfredo; Hugh, Tom; Aldrighetti, Luca; Weiss, Matthew J.; Bauer, Todd W.; Maithel, Shishir K.; Pulitano, Carlo; Shen, Feng; Koerkamp, Bas Groot; Endo, Itaru; Pawlik, Timothy M.

doi:10.1245/s10434-020-08548-w

Cited by 70 publications

(98 citation statements)

References 35 publications

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“…HCC is the sixth most common cancer and, due to its poor prognosis, the third leading cause of cancer-related death worldwide. 3,24 While the incidence of hepatitis-related HCC has decreased with vaccination and more effective antiviral therapies, the worldwide epidemic of obesity has increased the incidence of non-alcoholic fatty liver disease (NAFLD) and NAFLD-related HCC. 25 Although the peak age of HCC occurrence varies considerably worldwide, due to the different distribution of etiologic factors, the number of elderly and extremely elderly patients diagnosed with HCC is expected to increase in most developed areas.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 Despite improvements in surgical technique and perioperative care, an estimated 20% to 30% of patients undergoing hepatectomy will still experience a postoperative complication; in addition, 1 in 10 patients will have a severe postoperative complication. 3,4 Consequently, hepatectomy-especially in the setting of complications-has been associated with increased length of stay (LOS) and costs. 3,5,6 In fact, the occurrence of a major complication can add over $30,000 of extra cost and increase the mean LOS by over 8 days.…”

Section: Introductionmentioning

confidence: 99%

“…3,4 Consequently, hepatectomy-especially in the setting of complications-has been associated with increased length of stay (LOS) and costs. 3,5,6 In fact, the occurrence of a major complication can add over $30,000 of extra cost and increase the mean LOS by over 8 days. 5 In addition, patients who experience a complication following hepatectomy may be at higher risk for readmission and need additional discharge planning.…”

Section: Introductionmentioning

confidence: 99%

“…14 While several studies have evaluated postoperative outcomes among patients undergoing hepatic resection, trends in discharge disposition among patients following hepatectomy have not been investigated. [2][3][4]15 Such data may be helpful in planning discharge disposition and designing an effective postoperative treatment strategy. Therefore, the current study's objective was to characterize discharge disposition trends over the last decade among patients who underwent hepatic resection for hepatocellular carcinoma (HCC).…”

Section: Introductionmentioning

confidence: 99%

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Trends in Discharge Disposition Following Hepatectomy for Hepatocellular Carcinoma Among Medicare Beneficiaries

Dalmacy

Hyer

Díaz

et al. 2021

Journal of Gastrointestinal Surgery

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Background Post-acute care (PAC) services can include home healthcare, long-term care hospitals, and skilled nursing facilities. We sought to define factors associated with PAC discharge disposition among Medicare beneficiaries who underwent hepatectomy for hepatocellular carcinoma (HCC). Methods Data for Medicare beneficiaries with a diagnosis of HCC and who underwent a hepatectomy between 2004 and 2015 were retrieved from the SEER-Medicare database. Discharge disposition was defined as routine (HSC: discharged to home) or non-routine (SNF/ICF, discharged to skilled nursing/intermediate care facilities, or HHA, discharge to home with home health agency). The Cochran-Mantel-Haenszel test and multivariable logistic regression were used to assess trends in discharge disposition. Results Among 1305 patients, the median patient age at diagnosis was 72 years (IQR: 68-76). Approximately 4 in 5 patients were discharged to HSC (77.4%; n = 1010). The odds of a non-routine discharge decreased by 7.0% annually from 2004 to 2015 (OR trend , 0.93; 95%CI, 0.89-0.97; p trend = 0.001). Several factors were associated with non-routine discharge, including patient age (OR 1.06, 95%CI 1.04-1.09) and longer LOS (OR 1.07, 95%CI 1.05-1.10). In contrast, patients who had a minor hepatectomy (OR 0.69, 95%CI 0.52-0.93) at a teaching hospital (OR 0.63, 95%CI 0.45-0.89) had lower odds of a non-routine discharge (all P < 0.05).

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Trends in Discharge Disposition Following Hepatectomy for Hepatocellular Carcinoma Among Medicare Beneficiaries

Dalmacy

Hyer

Díaz

et al. 2021

Journal of Gastrointestinal Surgery

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“…Over the past decade, significant advances in diagnostic methods, surgical techniques and perioperative care have been made in the field of hepatopancreatobiliary (HPB) surgery. In turn, HPB surgeons have attempted to push the limits of resectability of liver tumors and, in particular, HCC over time [10,11] . In fact, major hepatectomies have been increasingly performed for large, multinodular tumors, as well as tumors invading the major vasculature [12] .…”

Section: Resection Beyond Bclc Criteria: Is It Justified In Select Patients?mentioning

confidence: 99%

Hepatocellular carcinoma beyond Barcelona clinic liver cancer resection criteria: resecting the aggressive tumor

Tsilimigras¹,

Pawlik²

2021

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According to the Barcelona Clinic Liver Cancer (BCLC) staging system, surgical resection is recommended only for BCLC-0 and BCLC-A hepatocellular carcinoma (HCC). Nevertheless, several investigators have recently advocated for widening the resection criteria for HCC to select patients with BCLC-B and less frequently BCLC-C tumors. The available studies have reported a 5-year survival rate ranging from 25% to 63% following resection of select patients with multinodular HCC. The role of liver resection for macrovascular invasive HCC still remains unclear. The present review aimed to summarize the available evidence regarding the outcomes of patients who underwent resection for BCLC-B/C HCC as well as highlight the proposed criteria for resection beyond the current BCLC guidelines.

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Assessment of Textbook Outcome in Laparoscopic and Open Liver Surgery

et al. 2021

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IMPORTANCE Textbook outcome (TO) is a composite measure that captures the most desirable surgical outcomes as a single indicator, yet to date TO has not been defined and assessed in the field of laparoscopic liver resection (LLR) and open liver resection (OLR).OBJECTIVE To obtain international agreement on the definition of TO in liver surgery (TOLS) and to assess the incidence of TO in LLR and OLR in a large international multicenter database using a propensity-score matched analysis.DESIGN, SETTING, AND PARTICIPANTS Patients undergoing LLR or OLR for all liver diseases between January 2011 and October 2019 were analyzed using a large international multicenter liver surgical database. An international survey was conducted among all members of the European-African Hepato-Pancreato-Biliary Association (E-AHPBA) and International Hepato-Pancreato-Biliary Association (IHPBA) to reach agreement on the definition of TOLS. The rate of TOLS was assessed for LLR and OLR before and after propensity-score matching. Factors associated with achieving TOLS were investigated.MAIN OUTCOMES AND MEASURES Textbook outcome, with TOLS defined as the absence of intraoperative incidents of grade 2 or higher, postoperative bile leak grade B or C, severe postoperative complications, readmission within 30 days after discharge, in-hospital mortality, and the presence of R0 resection margin.RESULTS A total of 8188 patients (4559 LLR; median age, 65 years [interquartile range, 55-73 years]; 2529 were male [55.8%] and 3629 OLR; median age, 64 years [interquartile range, 56-71 years]; 2204 were male [60.7%]) were included in the analysis of whom 69.1% achieved TOLS; 74.8% for LLR and 61.9% for OLR (P < .001). On multivariable analysis, American Society of Anesthesiologists grade III, previous abdominal surgery, histological diagnosis of colorectal liver metastases (odds ratio [OR], 0.656 [95% CI, 0.457-0.940]; P = .02), cholangiocarcinoma, non-CRLM, a tumor size of 30 mm or more, minor resection of posterior/superior segments (OR, 0.716 [95% CI, 0.577-0.887]; P = .002), anatomically major resection (OR, 0.579 [95% CI, 0.418-0.803]; P = .001), and nonanatomical resection (OR, 0.612 [95% CI, 0.476-0.788]; P < .001) were associated with a worse TOLS rate after LLR. For OLR, only histological diagnosis of cholangiocarcinoma (OR, 0.360 [95% CI, 0.214-0.607]; P < .001) and a tumor size of 30 mm or more (30-50 mm = OR, 0.718 [95% CI, 0.565-0.911]; P = .01; 50.1-100 mm = OR, 0.729 [95% CI, 0.554-0.960]; P = .02; >10 cm = OR, 0.550 [95% CI, 0.366-0.826]; P = .004) were associated with a worse TOLS rate. CONCLUSIONS AND RELEVANCEIn this multicenter study, TOLS was found to be a useful tool for assessing patient-level hospital performance and may have utility in optimizing patient outcomes after LLR and OLR.

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Assessing Textbook Outcomes Following Liver Surgery for Primary Liver Cancer Over a 12-Year Time Period at Major Hepatobiliary Centers

Cited by 70 publications

References 35 publications

Trends in Discharge Disposition Following Hepatectomy for Hepatocellular Carcinoma Among Medicare Beneficiaries

Trends in Discharge Disposition Following Hepatectomy for Hepatocellular Carcinoma Among Medicare Beneficiaries

Hepatocellular carcinoma beyond Barcelona clinic liver cancer resection criteria: resecting the aggressive tumor

Assessment of Textbook Outcome in Laparoscopic and Open Liver Surgery

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