Textbook Outcome After Major Liver Resection for Primary and Secondary Liver Tumors at Specialized German Hepatobiliary Centers: Analysis of the StuDoQ Liver Registry.

Abstract

Textbook outcome (TO) represents the most desirable outcome of surgical quality and care. This study examined the TO of cholangiocarcinoma (CCC), hepatocellular carcinoma (HCC), and colorectal liver metastasis (CRLM) from the StuDoQ liver registry as well as factors that may affect the TO. All major liver resections (≥ 3 segments) for CCC, HCC, and CRLM entered in the multicentric StuDoQ liver registry between 2019 and 2022 were retrospectively analyzed. TO was defined by the absence of intraoperative incidents ≥ grade 2 (Oslo criteria), postoperative bile leakage and posthepatectomy liver failure (B/C, ISGLS criteria), major complications (Dindo-Clavien ≥ 3A), 90-day readmission, and mortality rate as well as tumor-free resection margin. Pre- and intraoperative factors that may influence TO were assessed by multivariable analyses. In 30 participating centers, a total of 1082 major liver resections were performed for CCC (n = 396, 36%), HCC (n = 214, 20%), and CRLM (n = 472, 44%). TO was achieved in 470 (43%) cases, most often in CRLM (51%). Major complications and intraoperative incidents ≥ 2 were the most frequent limiting factors to achieve TO. Anemia (odds ratio (OR) 0.63, 95% confidence interval (CI) 0.47-0.85), simultaneous resection procedures to the liver resection (OR 0.56, 95% CI 0.36-0.88), hyperbilirubinemia (OR 0.53, 95% CI 0.34-0.83), and cholangitis (OR 0.51, 95% CI 0.28-0.94) were identified as modifiable risk factors preventing achievement of a TO. TO after major liver resection was achieved in less than 50% of cases in certified and high-volume HPB centers. Preoperative risk factors were identified that may allow to improve outcome quality.