Benchmarks and Geographic Differences in Gallbladder Cancer Surgery: An International Multicenter Study

Vega, Eduardo A.; Newhook, Timothy E.; Mellado, Sebastián; Ruzzenente, Andrea; Okuno, Masayuki; Bellis, Mario De; Panettieri, Elena; Ahmad, Mahmood; Merlo, Ignacio; Rojas, Jesus; Rose, Agostino Maria De; Nishino, Hiroto; Sinnamon, Andrew J.; Donadon, Matteo; Hauger, Marit S.; Guevara, Óscar; Muñoz, César; Denbo, Jason W.; Chun, Yun Shin; Cao, Hop S. Tran; Clariá, Rodrigo Sanchez; Tzeng, Ching‐Wei D.; Aretxabala, Xabier de; Vivanco, Marcelo; Brudvik, Kristoffer Watten; Seo, Satoru; Pekolj, Juan; Poultsides, George A.; Torzilli, Guido; Giuliante, Felice; Anaya, Daniel A.; Guglielmi, Alfredo; Viñuela, Eduardo; Vauthey, Jean‐Nicolas

doi:10.1245/s10434-023-13531-2

Cited by 9 publications

(3 citation statements)

References 44 publications

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“…An international multicenter study including 13 high-volume centers and 906 GB carcinoma patients with indented therapeutic surgery assessed the outcomes. Among them, 245 operations (27%) fulfilled the evaluation criteria, which included the following benchmark values: (1) Retrieved lymph nodes ≥ 4; (2) blood loss ≤ 350 mL; (3) blood transfusion ≤ 13%; (4) duration of operation ≤ 322 min; (5) hospitalization ≤ 8 d; (6) R1 resection (margin macroscopic infiltration) ≤ 7%; (7) overall complications ≤ 22%; and (8) complications of grade ≥ 3 at a rate of ≤ 11%[ 113 ].…”

Section: Managementmentioning

confidence: 99%

New trends in diagnosis and management of gallbladder carcinoma

Pavlidis,

Galanis,

Pavlidis

2024

World J Gastrointest Oncol

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Gallbladder (GB) carcinoma, although relatively rare, is the most common biliary tree cholangiocarcinoma with aggressiveness and poor prognosis. It is closely associated with cholelithiasis and long-standing large (> 3 cm) gallstones in up to 90% of cases. The other main predisposing factors for GB carcinoma include molecular factors such as mutated genes, GB wall calcification (porcelain) or mainly mucosal microcalcifications, and GB polyps ≥ 1 cm in size. Diagnosis is made by ultrasound, computed tomography (CT), and, more precisely, magnetic resonance imaging (MRI). Preoperative staging is of great importance in decision-making regarding therapeutic management. Preoperative staging is based on MRI findings, the leading technique for liver metastasis imaging, enhanced three-phase CT angiography, or magnetic resonance angiography for major vessel assessment. It is also necessary to use positron emission tomography (PET)-CT or 18F-FDG PET-MRI to more accurately detect metastases and any other occult deposits with active metabolic uptake. Staging laparoscopy may detect dissemination not otherwise found in 20%-28.6% of cases. Multimodality treatment is needed, including surgical resection, targeted therapy by biological agents according to molecular testing gene mapping, chemotherapy, radiation therapy, and immunotherapy. It is of great importance to understand the updated guidelines and current treatment options. The extent of surgical intervention depends on the disease stage, ranging from simple cholecystectomy (T1a) to extended resections and including extended cholecystectomy (T1b), with wide lymph node resection in every case or IV-V segmentectomy (T2), hepatic trisegmentectomy or major hepatectomy accompanied by hepaticojejunostomy Roux-Y, and adjacent organ resection if necessary (T3). Laparoscopic or robotic surgery shows fewer postoperative complications and equivalent oncological outcomes when compared to open surgery, but much attention must be paid to avoiding injuries. In addition to surgery, novel targeted treatment along with immunotherapy and recent improvements in radiotherapy and chemotherapy (neoadjuvant-adjuvant capecitabine, cisplatin, gemcitabine) have yielded promising results even in inoperable cases calling for palliation (T4). Thus, individualized treatment must be applied.

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Section: Managementmentioning

confidence: 99%

New trends in diagnosis and management of gallbladder carcinoma

Pavlidis,

Galanis,

Pavlidis

2024

World J Gastrointest Oncol

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“…Benchmarking is a methodology employed to establish comprehensive quality measures and has been applied to compare clinical outcomes against key performance indicators to evaluate the best possible performance among “benchmark cases” representing the “best case scenario.” 12 – 15 The benchmark value represents the best possible outcome, while the gap between the benchmark and actual performance signifies the potential for improvement. 14 , 16 As such, the goal of surgical benchmarking is to find hospitals that can serve as a standard reference to assess other center outcomes related to patient care. To this point, benchmarking can drive more efficient structures and workflows to improve patient outcomes.…”

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confidence: 99%

“…To this point, benchmarking can drive more efficient structures and workflows to improve patient outcomes. 10 , 14 , 16 – 18 …”

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Benchmarks in Liver Resection for Intrahepatic Cholangiocarcinoma

Alaimo,

Endo,

Catalano

et al. 2024

Ann Surg Oncol

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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.

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