Safety-related outcomes of the Japanese Society of Hepato-Biliary-Pancreatic Surgery board certification system for expert surgeons

Otsubo, Takehito; Kobayashi, Sho; Sano, Keiji; Misawa, Takeyuki; Ota, Terukazu; Katagiri, Seiji; Yanaga, Katsuhiko; Yamaue, Hiroki; Kokudo, Norihiro; Unno, Michiaki; Fujimoto, Jiro; Miura, Fumihiko; Miyazaki, Masaru; Yamamoto, Masakazu

doi:10.1002/jhbp.444

Cited by 60 publications

(63 citation statements)

References 22 publications

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“…However, the detailed analysis of recurrence pattern and the treatment for recurrence would not have been possible using population-based data [12,14]. In addition, although population-based analyses are said to better describe the outcomes achieved in routine practice [14], the trend in centralization of high-risk surgery is associated with improved shortas well as long-term outcomes [32][33][34][35][36][37][38][39][40][41][42]. Considering much better outcomes reported from high-volume liver centers [20,[43][44][45], the results demonstrated in the current study may reflect ideal practice in the near future when centralization is optimized for older patients with CRLMs undergoing hepatectomy.…”

Section: Discussionmentioning

confidence: 99%

Original Clinical Investigation Multidisciplinary Treatment for Colorectal Liver Metastases in Elderly Patients

Hata

Mise

Sato

et al. 2020

Preprint

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Background Limited data describe the therapeutic practice and outcomes of colorectal liver metastases (CRLMs) in elderly patients. We aimed to evaluate the impact of age on multidisciplinary treatment for CRLMs. Methods We reviewed treatment and outcomes for patients in different age groups who underwent initial hepatectomy for CRLMs from 2004 through 2012. Results We studied 462 patients who were divided into three groups by age: ≤ 64 years (n = 265), 65-74 years (n = 151), and ≥ 75 years (n = 46). The rate of major hepatectomy and incidence of postoperative complications did not differ between groups. Adjuvant chemotherapy was used less in the ≥ 75 -year group (19.6%) than that in the ≤ 64 (54.3%) or 65-74 age group (43.5%). Repeat hepatectomy for liver recurrence was performed less in the ≥ 75 -year group (35%) than in the ≤ 64 (57%) or 65-74 (66%) age group. The 5-year disease-specific survival (DSS) rate of 44.2% in the ≥ 75 -year group was lower than in the ≤ 64 (59.0%) or 65-74 (64.7%) age group. Multivariate analysis revealed age ≥ 75 years was an independent predictor of poor DSS. Conclusions Liver resection for CRLMs can be performed safely in elderly patients. However, repeat resection for recurrence are performed less frequently in the elderly, which may lead to the poorer disease-specific prognosis.

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Section: Discussionmentioning

confidence: 99%

Original Clinical Investigation Multidisciplinary Treatment for Colorectal Liver Metastases in Elderly Patients

Hata

Mise

Sato

et al. 2020

Preprint

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“…This study used data from the registry of the Japanese Society of Gastroenterological Surgery and the Japanese Society of Hepato‐Biliary‐Pancreatic Surgery. The database is housed in the National Clinical Database, a platform for major nationwide registries in Japan.…”

Section: Methodsmentioning

confidence: 99%

Risk model for severe postoperative complications after total pancreatectomy based on a nationwide clinical database

Hashimoto

Mizuma

Kumamaru

et al. 2020

British Journal of Surgery

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Background: Total pancreatectomy is required to completely clear tumours that are locally advanced or located in the centre of the pancreas. However, reports describing clinical outcomes after total pancreatectomy are rare. The aim of this retrospective observational study was to assess clinical outcomes following total pancreatectomy using a nationwide registry and to create a risk model for severe postoperative complications. Methods: Patients who underwent total pancreatectomy from 2013 to 2017, and who were recorded in the Japan Society of Gastroenterological Surgery and Japanese Society of Hepato-Biliary-Pancreatic Surgery database, were included. Severe complications at 30 days were defined as those with a Clavien-Dindo grade III needing reoperation, or grade IV-V. Occurrence of severe complications was modelled using data from patients treated from 2013 to 2016, and the accuracy of the model tested among patients from 2017 using c-statistics and a calibration plot. Results: A total of 2167 patients undergoing total pancreatectomy were included. Postoperative 30-day and in-hospital mortality rates were 1⋅0 per cent (22 of 2167 patients) and 2⋅7 per cent (58 of 167) respectively, and severe complications developed in 6⋅0 per cent (131 of 2167). Factors showing a strong positive association with outcome in this risk model were the ASA performance status grade and combined arterial resection. In the test cohort, the c-statistic of the model was 0⋅70 (95 per cent c.i. 0⋅59 to 0⋅81).Conclusion: The risk model may be used to predict severe complications after total pancreatectomy.

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“…However, the operative mortality and morbidity rates after HPB surgery are still high. Although the 90-day mortality rate after complex HPB surgery has been decreasing, it was reported to be 1.7% in Japan [2]. Furthermore, nationwide surveys in Japan revealed that postoperative morbidity rates after major hepatectomy and pancreaticoduodenectomy are 25.7 and 41.6% respectively [3,4].…”

Section: Introductionmentioning

confidence: 99%

“…Complex HPB surgery was defined according to the criteria of the Japanese Society of HepatoBiliary-Pancreatic Surgery [2]. The present study included 3 categories of procedures: hepatobiliary surgery, hepatopancreatic surgery, pancreatic surgery.…”

Section: Study Cohortmentioning

confidence: 99%

“…For enrolled patients, the following patient characteristics were evaluated as preoperative factors: age, sex (male, female), body mass index (BMI; ≤25, > 25), American Society of Anesthesiologists physical status (1)(2)(3)(4), laboratory values, liver function according to the Child-Pugh score (A or B), comorbidities (hypertension, diabetes, hyperlipidemia, cerebral disease, cardiac disease, chronic obstructive pulmonary disease), liver disease (hepatitis B virus and/or hepatitis C virus), chronic kidney disease, and etiology of the disease (hepatic disease, biliary disease, pancreatic disease, or miscellaneous). Patients were divided into 2 groups according to age, non-elderly (< 75 years) and elderly (≥75 years) according to the proposal of the Joint Committee of Japan Gerontological Society and the Japan Geriatrics Society [10].…”

Section: Clinical Datamentioning

confidence: 99%

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The Outcome of Complex Hepato-Pancreato-Biliary Surgery for Elderly Patients: A Propensity Score Matching Analysis

et al. 2018

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Background/Aims: Postoperative mortality and morbidity rates after hepato-pancreato-biliary (HPB) surgery remain high, and the number of elderly patients requiring such surgery has been increasing. This study aimed to investigate postoperative outcomes of complex HPB surgery for elderly patients. Methods: We retrospectively reviewed perioperative data of 721 patients who underwent complex HPB surgery between 2010 and 2015. The patients were divided into 2 groups: elderly (≥75 years) and non-elderly (< 75 years). Surgical outcomes of both groups were compared after propensity score-matching analysis. Subsequently, risk factors for serious postoperative morbidity were identified by multivariate analysis. Results: Before matching, the elderly group (n = 170) had more comorbidities, such as cardiovascular and renal disease, than the non-elderly group (n = 551). Matching yielded elderly (n = 170) and non-elderly groups (n = 170) with similar preoperative backgrounds. The mortality and morbidity rates did not differ significantly between the groups. In multivariate analyses, operative time (OR 1.79; p = 0.005) and blood loss (OR 1.66; p = 0.03) were identified as independent risk factors for serious postoperative morbidity, whereas older age did not have a predictive impact (OR 1.16; p = 0.52). Conclusions: Although elderly patients had more comorbidities and higher incidences of postoperative mortality and several complications before matching, their postoperative outcomes were equivalent to those of non-elderly patients after matching.

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Safety-related outcomes of the Japanese Society of Hepato-Biliary-Pancreatic Surgery board certification system for expert surgeons

Cited by 60 publications

References 22 publications

Original Clinical Investigation Multidisciplinary Treatment for Colorectal Liver Metastases in Elderly Patients

Original Clinical Investigation Multidisciplinary Treatment for Colorectal Liver Metastases in Elderly Patients

Risk model for severe postoperative complications after total pancreatectomy based on a nationwide clinical database

The Outcome of Complex Hepato-Pancreato-Biliary Surgery for Elderly Patients: A Propensity Score Matching Analysis

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