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

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Introduction

The objective of the current study was to comprehensively assess the change of practice in hepatobiliary surgery by determining the rates and the trends of textbook outcomes (TO) among patients undergoing surgery for primary liver cancer over time.

Methods

Patients undergoing curative-intent resection for primary liver malignancies, including hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) between 2005 and 2017 were analyzed using a large, international multi-institutional dataset. Rates of TO were assessed over time. Factors associated with achieving a TO and the impact of TO on long-term survival were examined.

Results

Among 1829 patients, 944 (51.6%) and 885 (48.4%) individuals underwent curative-intent resection for HCC and ICC, respectively. Over time, patients were older, more frequently had ASA class > 2, albumin-bilirubin grade 2/3, major vascular invasion and more frequently underwent major liver resection (all p < 0.05). Overall, a total of 1126 (62.0%) patients achieved a TO. No increasing trends in TO rates were noted over the years (ptrend = 0.90). In addition, there was no increasing trend in the TO rates among patients undergoing either major (ptrend = 0.39) or minor liver resection (ptrend = 0.63) over the study period. Achieving a TO was independently associated with 26% and 37% decreased hazards of death among ICC (HR 0.74, 95%CI 0.56–0.97) and HCC patients (HR 0.63, 95%CI 0.46–0.85), respectively.

Conclusion

Approximately 6 in 10 patients undergoing surgery for primary liver tumors achieved a TO. While TO rates did not increase over time, TO was associated with better long-term outcomes following liver resection for both HCC and ICC.

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Funding

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Author information

Author notes

  1. Diamantis I. Tsilimigras and Kota Sahara have contributed equally to this work.

Authors and Affiliations

  1. Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA

    Diamantis I. Tsilimigras MD, Kota Sahara MD, Dimitrios Moris MD, PhD, Rittal Mehta MPH, BDS, Anghela Z. Paredes MD, MS & Timothy M. Pawlik MD, MPH, PhD

  2. Department of Surgery, Ospedale San Raffaele, Milan, Italy

    Francesca Ratti MD & Luca Aldrighetti MD

  3. Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal

    Hugo P. Marques MD

  4. Department of Hepatobiliopancreatic Surgery, AP-HP, Beaujon Hospital, Clichy, France

    Olivier Soubrane MD

  5. Department of Surgery, Westmead Hospital, Sydney, NSW, Australia

    Vincent Lam MD

  6. Department of Surgery, Stanford University, Stanford, CA, USA

    George A. Poultsides MD

  7. Department of Surgery, Fundeni Clinical Institute, Bucharest, Romania

    Irinel Popescu MD & Sorin Alexandrescu MD

  8. Department of Surgery, University of Ottawa, Ottawa, ON, Canada

    Guillaume Martel MD & Aklile Workneh MD

  9. Department of Surgery, University of Verona, Verona, Italy

    Alfredo Guglielmi MD

  10. Department of Surgery, The University of Sydney, Sydney, NSW, Australia

    Tom Hugh MD

  11. Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA

    Matthew Weiss MD

  12. Department of Surgery, University of Virginia, Charlottesville, VA, USA

    Todd W. Bauer MD

  13. Department of Surgery, Emory University, Atlanta, GA, USA

    Shishir K. Maithel MD

  14. Department of Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia

    Carlo Pulitano MD

  15. Department of Surgery, Eastern Hepatobiliary Surgery Hospital, Shanghai, China

    Feng Shen MD

  16. Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands

    Bas Groot Koerkamp MD

  17. Department of Gastroenterological Surgery, Yokohama City University School of Medicine, Yokohama, Japan

    Itaru Endo MD, PhD

  18. Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University, Wexner Medical Center, Columbus, OH, USA

    Timothy M. Pawlik MD, MPH, PhD

Authors
  1. Diamantis I. Tsilimigras MD
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  2. Kota Sahara MD
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Corresponding author

Correspondence to Timothy M. Pawlik MD, MPH, PhD.

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Supplemental Fig. 1

Textbook outcome rates stratified by procedure type (TIFF 85 kb)

Supplemental Fig. 2

Textbook outcome rates among patients treated at Eastern versus Western institutions (TIFF 189 kb)

Supplemental Fig. 3

Incidence of overall textbook outcome and individual TO components among patients treated in the early (2005–2008) versus late (2013–2017) study periods on PSM analysis (TIFF 482 kb)

Supplemental Fig. 4

Kaplan Meier curves demonstrating differences in overall survival among patients treated in the early (2005–2008) versus late (2013–2017) study periods on PSM analysis (TIFF 98 kb)

Supplementary material 5 (DOCX 17 kb)

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Tsilimigras, D.I., Sahara, K., Moris, D. et al. Assessing Textbook Outcomes Following Liver Surgery for Primary Liver Cancer Over a 12-Year Time Period at Major Hepatobiliary Centers. Ann Surg Oncol 27, 3318–3327 (2020). https://doi.org/10.1245/s10434-020-08548-w

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