• Matteo Mueller, Eva Breuer, Takashi Mizuno, Fabian Bartsch, Francesca Ratti, Christian Benzing, Noémie Ammar-Khodja, Teiichi Sugiura, Tsukasa Takayashiki, Amelia Hessheimer, Hyung Sun Kim, Andrea Ruzzenente, Keun Soo Ahn, Tiffany Wong, Jan Bednarsch, Mizelle D'Silva, KoerkampBas GrootBGDepartment of Surgery, Division of HPB and Transplant Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands., Heithem Jeddou, Victor López-López, Charles de Ponthaud, Jennifer A Yonkus, Warsan Ismail, Lynn E Nooijen, Camila Hidalgo-Salinas, Elissaios Kontis, Kim C Wagner, Ganesh Gunasekaran, Ryota Higuchi, Ana Gleisner, Chaya Shwaartz, Gonzalo Sapisochin, Richard D Schulick, Masakazu Yamamoto, Takehiro Noji, Satoshi Hirano, Myron Schwartz, Karl J Oldhafer, Andreas Prachalias, Giuseppe K Fusai, Joris I Erdmann, Pål-Dag Line, Rory L Smoot, Olivier Soubrane, Ricardo Robles-Campos, Karim Boudjema, Wojciech G Polak, Ho-Seong Han, Ulf P Neumann, Chung-Mau Lo, Koo Jeong Kang, Alfredo Guglielmi, Joon Seong Park, Constantino Fondevila, Masayuki Ohtsuka, Katsuhiko Uesaka, René Adam, Johann Pratschke, Luca Aldrighetti, Michelle L De Oliveira, Gregory J Gores, Hauke Lang, Masato Nagino, and Pierre-Alain Clavien.
• Department of Surgery and Transplantation, Swiss HPB Center, University Hospital Zurich, Switzerland.
• Ann. Surg. 2021 Nov 1; 274 (5): 780-788.

ObjectiveThe aim of this study was to define robust benchmark values for the surgical treatment of perihilar cholangiocarcinomas (PHC) to enable unbiased comparisons.BackgroundDespite ongoing efforts, postoperative mortality and morbidity remains high after complex liver surgery for PHC. Benchmark data of best achievable results in surgical PHC treatment are however still lacking.MethodsThis study analyzed consecutive patients undergoing major liver surgery for PHC in 24 high-volume centers in 3 continents over the recent 5-year period (2014-2018) with a minimum follow-up of 1 year in each patient. Benchmark patients were those operated at high-volume centers (≥50 cases during the study period) without the need for vascular reconstruction due to tumor invasion, or the presence of significant co-morbidities such as severe obesity (body mass index ≥35), diabetes, or cardiovascular diseases. Benchmark cutoff values were derived from the 75th or 25th percentile of the median values of all benchmark centers.ResultsSeven hundred eight (39%) of a total of 1829 consecutive patients qualified as benchmark cases. Benchmark cut-offs included: R0 resection ≥57%, postoperative liver failure (International Study Group of Liver Surgery): ≤35%; in-hospital and 3-month mortality rates ≤8% and ≤13%, respectively; 3-month grade 3 complications and the CCI: ≤70% and ≤30.5, respectively; bile leak-rate: ≤47% and 5-year overall survival of ≥39.7%. Centers operating mostly on complex cases disclosed better outcome including lower post-operative liver failure rates (4% vs 13%; P = 0.002). Centers from Asia disclosed better outcomes.ConclusionSurgery for PHC remains associated with high morbidity and mortality with now the availability of benchmark values covering 21 outcome parameters, which may serve as key references for comparison in any future analyses of individuals, group of patients or centers.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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