Novel Benchmark Values for Open Major Anatomic Liver Resection in Non-cirrhotic Patients: A Multicentric Study of 44 International Expert Centers

Richard X. Sousa Da Silva, Eva Breuer, Sadhana Shankar, Shoji Kawakatsu, Wacław Hołówko, João Santos Coelho, Heithem Jeddou, Teiichi Sugiura, Mohammed Ghallab, Doris Da Silva, Genki Watanabe, Florin Botea, Nozomu Sakai, Pietro Addeo, Stylianos Tzedakis, Fabian Bartsch, Kaja Balcer, Chetana Lim, Fabien Werey, Victor Lopez-LopezLuciana Peralta Montero, Rodrigo Sanchez Claria, Jennifer Leiting, Neeta Vachharajani, Eve Hopping, Orlando J.M. Torres, Satoshi Hirano, Daan Andel, Jeroen Hagendoorn, Alicja Psica, Matteo Ravaioli, Keun Soon Ahn, Tim Reese, Leonardo A. Montes, Ganesh Gunasekaran, Cándido Alcázar, Jin Hong Lim, Muhammad Haroon, Qian Lu, Antonio Castaldi, Tatsuya Orimo, Beat Moeckli, Teresa Abadía, Luis Ruffolo, Josefina Dib Hasan, Francesca Ratti, Emmanuele F. Kauffmann, Roeland F. De Wilde, Wojciech G. Polak, Ugo Boggi, Luca Aldrighetti, Lucas McCormack, Roberto Hernandez-Alejandro, Alejandro Serrablo, Christian Toso, Akinobu Taketomi, Jean Gugenheim, Jiahong Dong, Faisal Hanif, Joon Seong Park, José M. Ramia, Myron Schwartz, Diego Ramisch, Michelle L. De Oliveira, Karl J. Oldhafer, Koo Jeong Kang, Matteo Cescon, Peter Lodge, Inne H.M.Borel Rinkes, Takehiro Noji, John Edwin Thomson, Su Kah Goh, William C. Chapman, Sean P. Cleary, Juan Pekolj, Jean Marc Regimbeau, Olivier Scatton, Stéphanie Truant, Hauke Lang, David Fuks, Philippe Bachellier, Masayuki Ohtsuka, Irinel Popescu, Kiyoshi Hasegawa, Mickaël Lesurtel, René Adam, Daniel Cherqui, Katsuhiko Uesaka, Karim Boudjema, Hugo Pinto-Marques, Michał Grąt, Henrik Petrowsky, Tomoki Ebata, Andreas Prachalias, Ricardo Robles-Campos, Pierre Alain Clavien

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Objective: This study aims at establishing benchmark values for best achievable outcomes following open major anatomic hepatectomy for liver tumors of all dignities. Background: Outcomes after open major hepatectomies vary widely lacking reference values for comparisons among centers, indications, types of resections, and minimally invasive procedures. Methods: A standard benchmark methodology was used covering consecutive patients, who underwent open major anatomic hepatectomy from 44 high-volume liver centers from 5 continents over a 5-year period (2016-2020). Benchmark cases were low-risk non-cirrhotic patients without significant comorbidities treated in high-volume centers (≥30 major liver resections/year). Benchmark values were set at the 75th percentile of median values of all centers. Minimum follow-up period was 1 year in each patient. Results: Of 8044 patients, 2908 (36%) qualified as benchmark (low-risk) cases. Benchmark cutoffs for all indications include R0 resection ≥78%; liver failure (grade B/C) ≤10%; bile leak (grade B/C) ≤18%; complications ≥grade 3 and CCI® ≤46% and ≤9 at 3 months, respectively. Benchmark values differed significantly between malignant and benign conditions so that reference values must be adjusted accordingly. Extended right hepatectomy (H1, 4-8 or H4-8) disclosed a higher cutoff for liver failure, while extended left (H1-5,8 or H2-5,8) were associated with higher cutoffs for bile leaks, but had superior oncologic outcomes, when compared to formal left hepatectomy (H1-4 or H2-4). The minimal follow-up for a conclusive outcome evaluation following open anatomic major resection must be 3 months. Conclusion: These new benchmark cutoffs for open major hepatectomy provide a powerful tool to convincingly evaluate other approaches including parenchymal-sparing procedures, laparoscopic/robotic approaches, and alternative treatments, such as ablation therapy, irradiation, or novel chemotherapy regimens.

Original languageEnglish
Pages (from-to)748-755
Number of pages8
JournalAnnals of surgery
Issue number5
StatePublished - Nov 1 2023


  • CCI
  • benchmarks
  • complications
  • formal and extended hepatectomy
  • liver resection
  • malignant and benign tumors
  • open major hepatectomy
  • outcomes


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