• Annals of surgery · Jun 2024

    Harmonizing Definitions and Perspectives in Extreme Liver Surgery: A Delphi Experts Consensus.

    • Victor Lopez-Lopez, Peter Lodge, Karl Oldhafer, Roberto Hernandez-Alejandro, Nobuhisa Akamatsu, Goro Honda, Antonio Pinna, Deniz Balci, Sanjay Govil, Umberto Cillo, Andrea Schlegel, Silvio Nadalin, Fabrizio Di Benedetto, Johann Pratschke, Luca Aldrighetti, Olivier Soubrane, Olivier Scatton, Go Wakabayashi, Irinel Popescu, Jose Manuel Ramia, Masayuki Ohtsuka, Pål-Dag Line, Roberto Ivan Troisi, Marcel A Machado, Giuseppe Kito Fusai, Gonzalo Sapisochin, Juan Pekolj, Silvio Balzan, Constantino Fondevila, Ho-Seong Han, Mickaël Lesurtel, Hugo Pinto-Marques, Krishna Menon, Fernando Rotellar, Wojciech G Polak, Cristina Dopazo, Santiago Lopez-Ben, Guido Torzilli, Emilio de Vicente, Juan de la Cruz, Mariana Chavez-Villa, David Ferreras, Alejandro Serrablo, Eduardo De Santibañez, Pierre-Alain Clavien, Daniel Azoulay, and Ricardo Robles-Campos.
    • Clinic and University Virgen de la Arrixaca Hospital, IMIB-Arrixaca - Murcia (Spain).
    • Ann. Surg. 2024 Jun 28.

    ObjectiveTo propose to our community a common language about extreme liver surgery.BackgroundThe lack of a clear definition of extreme liver surgery prevents convincing comparisons of results among centers.MethodsWe used a two-round Delphi methodology to quantify consensus among liver surgery experts. For inclusion in the final recommendations, we established a consensus when the positive responses (agree and totally agree) exceeded 70%. The study steering group summarized and reported the recommendations. In general, a five-point Likert scale with a neutral central value was used, and in a few cases multiple choices. Results are displayed as numbers and percentages.ResultsA two-round Delphi study was completed by 38 expert surgeons in complex hepatobiliary surgery. The surgeon´s median age was 58 years old (52-63) and the median years of experience was 25 years (20-31). For the proposed definitions of total vascular occlusion, hepatic flow occlusion and inferior vein occlusion, the degree of agreement was 97%, 81% and 84%, respectively. In situ approach (64%) was the preferred, followed by ante situ (22%) and ex situ (14%). Autologous or cadaveric graft for hepatic artery or hepatic vein repair were the most recommended (89%). The use of veno-venous bypass or portocaval shunt revealed the divergence depending on the case. Overall, 75% of the experts agreed with the proposed definition for extreme liver surgery.ConclusionObtaining a consensus on the definition of extreme liver surgery is essential to guarantee the correct management of patients with highly complex hepatobiliary oncological disease. The management of candidates for extreme liver surgery involves comprehensive care ranging from adequate patient selection to the appropriate surgical strategy.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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