• Y Kawaguchi, K Hasegawa, Tzeng C-W D CD Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA., T Mizuno, J Arita, Y Sakamoto, Y S Chun, T A Aloia, N Kokudo, and J-N Vauthey.
• Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
• Br J Surg. 2020 Feb 1; 107 (3): 258-267.

BackgroundTraditional classifications for open liver resection are not always associated with surgical complexity and postoperative morbidity. The aim of this study was to test whether a three-level classification for stratifying surgical complexity based on surgical and postoperative outcomes, originally devised for laparoscopic liver resection, is superior to classifications based on a previously reported survey for stratifying surgical complexity of open liver resections, minor/major nomenclature or number of resected segments.MethodsPatients undergoing a first open liver resection without simultaneous procedures at MD Anderson Cancer Center (Houston cohort) or the University of Tokyo (Tokyo cohort) were studied. Surgical and postoperative outcomes were compared among three grades: I (wedge resection for anterolateral or posterosuperior segment and left lateral sectionectomy); II (anterolateral segmentectomy and left hepatectomy); III (posterosuperior segmentectomy, right posterior sectionectomy, right hepatectomy, central hepatectomy and extended left/right hepatectomy).ResultsIn both the Houston (1878 patients) and Tokyo (1202) cohorts, duration of operation, estimated blood loss and comprehensive complication index score differed between the three grades (all P < 0·050) and increased in stepwise fashion from grades I to III (all P < 0·001). Left hepatectomy was associated with better surgical and postoperative outcomes than right hepatectomy, extended right hepatectomy and right posterior sectionectomy, although these four procedures were categorized as being of medium complexity in the survey-based classification. Surgical outcomes of minor open liver resections also differed between the three grades (all P < 0·050). For duration of operation and blood loss, the area under the curve was higher for the three-level classification than for the minor/major or segment-based classification.ConclusionThe three-level classification may be useful in studies analysing open liver resection at Western and Eastern centres.© 2019 BJS Society Ltd Published by John Wiley & Sons Ltd.

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