• ChanAlbert C YACYDepartment of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China.Department of Surgery, HKU-Shenzhen Hospital, The University of Hong Kong, Shenzhen, China., ChokKenneth S HKSHDepartment of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China., Jeff Dai, TsangSimon H YSHYDepartment of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China., Tan To Cheung, Ronnie Poon, S T Fan, and C M Lo.
• Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China.
• Ann. Surg. 2022 May 1; 275 (5): e690e697e690-e697.

ObjectiveTo study the impact of LT experience on the outcome of CLR for locally advanced hepatobiliary malignancy.Summary Of Background DataDespite evolution in LT knowledge and surgical techniques in the past decades, there is yet data to evaluate the significance of LT experience in performing CLR.MethodsPostoperative outcome after CLR between 1995 and 2019 were reviewed and correlated with LT experience in a single center with both LT and CLR service. CLR was defined as hepatectomy with vasculobiliary reconstruction, or multivisceral resection, central bisectionectomy (S4/5/8), or associating liver partition and portal vein ligation for staged hepatectomy. Spearman rank correlation and receiver operating characteristic analysis were used to define the association between CLR-related outcomes and LT experience.ResultsWith cumulative single-center experience of 1452 LT, 222 CLR were performed during the study period [hepatectomy with biliary (27.0%), or vascular (21.2%) reconstruction, with multivisceral resections (9.9%), with associating liver partition and portal vein ligation for staged hepatectomy (18.5%)] mainly for hepatocellular carcinoma (53.2%), and hilar cholangiocarcinoma (14%). Median tumor size was 7.0 cm. Other features include macrovascular invasion (23.4%), and juxta-visceral invasion (14%). Major postoperative complication rate was 25.2% and mortality rate was 6.3%. CLR-complication rate was inversely associated with LT experience (R = -0.88, P < 0.005). Receiver operator characteristic analysis revealed the cutoff for LT experience to have the greatest influence on CLR was 95 with a sensitivity of 100% and Youden index of 1. Multivariable analysis showed that blood transfusion, prolonged operating time, LT experience < /=95 were associated with major postoperative complications.ConclusionLT experience was complimentary to CLR for locally advanced hepatobiliary malignancy with improved postoperative outcome.Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

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