• Annals of surgery · Aug 2023

    Textbook Outcomes following Open Live Donor Right Hepatectomy and Open Right Hepatic Lobectomy for Cancer in 686 patients: Re-defining the Benchmark.

    • Epameinondas Dogeas, David A Geller, Samer Tohme, Jennifer Steel, Winifred Lo, Brittany Morocco, Amit Tevar, Michele Molinari, Christopher Hughes, and Abhinav Humar.
    • Divisions of Hepatobiliary and Pancreatic Surgery and Transplant Surgery, Department of Surgery, Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA.
    • Ann. Surg. 2023 Aug 1; 278 (2): e256e263e256-e263.

    ObjectiveTo compare textbook outcomes (TO) of open live donor right hepatectomy (RH) versus open right hepatic lobectomy for cancer in a single Western center and to identify clinical factors associated with failure to achieve a TO.BackgroundTO, a composite quality measure that captures multiple aspects of perioperative care, has not been thoroughly studied in open RH. We hypothesized that TO rates after RH for live donor transplant could represent the "best-achievable" results of this operation and could serve as the benchmark for RH performed for an oncologic indication.MethodsA prospective database was reviewed to compare TO rates after RH for live donor purposes versus RH for cancer at a single center from 2010 to 2020. A TO was defined as achieving 7 metrics: no perioperative transfusion, no major postoperative complications, no significant bile leak, no unplanned transfer to the ICU, no 30-day mortality, no 30-day readmission, and no R1 margins for cancer cases.ResultsAmong 686 RH patients (371 live donor and 315 cancer cases), a TO was achieved in 92.2% of RH donors and 53.7% of RH cancer cases. Live donor patients tended to be younger, healthier, and thinner. Among donors, increased intraoperative blood loss, and in cancer cases, male sex, tumor size, and increased intraoperative blood loss were associated with TO failure.ConclusionsA TO can be achieved in over 90% of patients undergoing living donor RH and in approximately half of RH cancer cases. These metrics represent a new benchmark for "real-world" TO after open RH.Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.

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