Guido Costa, Matteo Donadon, Federica Cipriani, Matteo Serenari, Francesco Ardito, Andrea Fontana, Daniele Nicolini, Pasquale Perri, Maurizio Iaria, Mattia Garancini, Ottavia Cicerone, Matteo Zanello, Quirino Lai, Simone Conci, Sarah Molfino, Cecilia Ferrari, Paola Germani, Mauro Zago, Giuseppe Zimmitti, Giuliano La Barba, Maurizio Romano, Ivano Sciannamea, Luca Fumagalli, Albert Troci, Valentina Ferraro, Riccardo Memeo, Michele Crespi, Marco Chiarelli, Adelmo Antonucci, Giacomo Zanus, Giorgio Ercolani, Moh'd Abu Hilal, Enrico Pinotti, Paola Tarchi, Guido Griseri, Gian L Baiocchi, Andrea Ruzzenente, Massimo Rossi, Elio Jovine, Marcello Maestri, Fabrizio Romano, Raffaele D Valle, Gian L Grazi, Marco Vivarelli, Alessandro Ferrero, Felice Giuliante, Matteo Cescon, Luca Aldrighetti, Guido Torzilli
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引用次数: 0
Abstract
Background: Liver resection classifications have traditionally been based on the number of segments resected. However, with advancements in techniques and the diffusion of minimally invasive surgery (MiLS), these classifications may no longer adequately represent the complexities of modern liver surgery. This study evaluates five liver resection classifications using a multicenter Italian database of hepatocellular carcinoma resections with the main focus of catching surgical outcomes, rather than technical complexity.
Methods: The study included 3280 resections (2436 open, 844 MiLS) from 25 Italian centers. Five classifications were assessed: Minor-Major, Segment-based, GK-LLR, S-L OLR, and CLISCO. Outcomes included morbidity, liver failure, and 90-day mortality. Chi-square or Fisher's exact tests were used for comparisons.
Results: All classifications showed increased morbidity and mortality with higher complexity. For open resections, Minor-Major and Segment-based classifications successfully stratified patients for all outcomes, outperforming other systems. However, all classifications performed poorly for MiLS patients.
Discussion: Minor-Major and Segment-based classifications remain the most accurate for predicting risks in open liver resections. The poor performance for MiLS patients highlights the need for a separate risk stratification tool for this approach. Current classifications do not always accurately represent the technical complexity and technological evolution in liver resection, particularly for MiLS procedures.
期刊介绍：
HPB is an international forum for clinical, scientific and educational communication.
Twelve issues a year bring the reader leading articles, expert reviews, original articles, images, editorials, and reader correspondence encompassing all aspects of benign and malignant hepatobiliary disease and its management. HPB features relevant aspects of clinical and translational research and practice.
Specific areas of interest include HPB diseases encountered globally by clinical practitioners in this specialist field of gastrointestinal surgery. The journal addresses the challenges faced in the management of cancer involving the liver, biliary system and pancreas. While surgical oncology represents a large part of HPB practice, submission of manuscripts relating to liver and pancreas transplantation, the treatment of benign conditions such as acute and chronic pancreatitis, and those relating to hepatobiliary infection and inflammation are also welcomed. There will be a focus on developing a multidisciplinary approach to diagnosis and treatment with endoscopic and laparoscopic approaches, radiological interventions and surgical techniques being strongly represented. HPB welcomes submission of manuscripts in all these areas and in scientific focused research that has clear clinical relevance to HPB surgical practice.
HPB aims to help its readers - surgeons, physicians, radiologists and basic scientists - to develop their knowledge and practice. HPB will be of interest to specialists involved in the management of hepatobiliary and pancreatic disease however will also inform those working in related fields.
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HPB is owned by the International Hepato-Pancreato-Biliary Association (IHPBA) and is also the official Journal of the American Hepato-Pancreato-Biliary Association (AHPBA), the Asian-Pacific Hepato Pancreatic Biliary Association (A-PHPBA) and the European-African Hepato-Pancreatic Biliary Association (E-AHPBA).
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