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Harmonizing Definitions and Perspectives in Extreme Liver Surgery: A Delphi Experts Consensus.
Lopez-Lopez, Victor; Lodge, Peter; Oldhafer, Karl; Hernandez-Alejandro, Roberto; Akamatsu, Nobuhisa; Honda, Goro; Pinna, Antonio; Balci, Deniz; Govil, Sanjay; Cillo, Umberto; Schlegel, Andrea; Nadalin, Silvio; Di Benedetto, Fabrizio; Pratschke, Johann; Aldrighetti, Luca; Soubrane, Olivier; Scatton, Olivier; Wakabayashi, Go; Popescu, Irinel; Ramia, Jose Manuel; Ohtsuka, Masayuki; Line, Pål-Dag; Troisi, Roberto Ivan; Machado, Marcel A; Fusai, Giuseppe Kito; Sapisochin, Gonzalo; Pekolj, Juan; Balzan, Silvio; Fondevila, Constantino; Han, Ho-Seong; Lesurtel, Mickaël; Pinto-Marques, Hugo; Menon, Krishna; Rotellar, Fernando; Polak, Wojciech G; Dopazo, Cristina; Lopez-Ben, Santiago; Torzilli, Guido; de Vicente, Emilio; de la Cruz, Juan; Chavez-Villa, Mariana; Ferreras, David; Serrablo, Alejandro; De Santibañez, Eduardo; Clavien, Pierre-Alain; Azoulay, Daniel; Robles-Campos, Ricardo.
Afiliação
  • Lopez-Lopez V; Clinic and University Virgen de la Arrixaca Hospital, IMIB-Arrixaca - Murcia (Spain).
  • Lodge P; St James's University Hospital, Leeds (United Kingdom).
  • Oldhafer K; Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, Asklepios Hospital Barmbek, Hamburg, Germany; Semmelweis University, Asklepios Campus Hamburg - Hamburg (Germany).
  • Hernandez-Alejandro R; Department of Liver Transplantation, University of Rochester Medical Center - Rochester (United States).
  • Akamatsu N; Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo - Tokyo (Japan).
  • Honda G; Department of Hepatobiliary-Pancreatic Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Shinjuku-Ku - Tokyo (Japan).
  • Pinna A; The Department of General Surgery, Transplant Center, Cleveland Clinic - Florida (United States).
  • Balci D; Department of General Surgery and Organ Transplantation Bahcesehir University School of Medicine - Istanbul (Turkey).
  • Govil S; Apollo Integrated Liver Care, Apollo Hospital, 154/11 Bannerghatta Road, Bengaluru 560076 - Karnataka (India).
  • Cillo U; General Surgery-Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, - Padua (Italy).
  • Schlegel A; Department of Liver Transplantation, Cleveland Clinic Foundation, Cleveland, Oh, Usa. - Ohio (United States).
  • Nadalin S; Department of General, Visceral and Transplant Surgery, University Hospital - Tübigen (Germany).
  • Di Benedetto F; Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University Hospital of Modena "policlinico", University Of Modena And Reggio Emilia - Modena (Italy).
  • Pratschke J; Department of Surgery, Campus Virchow Klinikum and Campus Charité Mitte, Charité-Universitätsmedizin Berlin - Berlin (Germany).
  • Aldrighetti L; Department of Surgery, Ospedale San Raffaele - Milan (Italy).
  • Soubrane O; Department of Digestive, Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Université de Paris Cité - Paris (France).
  • Scatton O; Ap-Hp Sorbonne Université, Hôpital Universitaire Pitié-Salpêtrière, Service de Chirurgie Digestive - Paris (France).
  • Wakabayashi G; Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital - Saitama (Japan).
  • Popescu I; Department of Surgery, Fundeni Clinical Institute - Bucharest (Romania).
  • Ramia JM; Servicio de Cirugía General y Aparato Digestivo, Hospital General Universitario de Alicante - Alicante (Spain).
  • Ohtsuka M; Department of General Surgery, Graduate School of Medicine, Chiba University - Chiba (Japan).
  • Line PD; Department of Transplantation Medicine, Oslo University Hospital - Oslo, &Institutue of Clinical Medicine, Universtiyof Oslo (Norway).
  • Troisi RI; Department of Clinical Medicine and Surgery, Division of HPB, Minimally Invasive and Robotic Surgery, Transplantation Service, Federico Ii University Hospital - Naples (Italy).
  • Machado MA; Department of Surgery, Nove de Julho Hospital, São Paulo, Brazil.
  • Fusai GK; Royal Free Hospital - London (United Kingdom).
  • Sapisochin G; Department of Abdominal Transplant and HPB Surgical Oncology, Toronto General Hospital, University of Toronto - Toronto (Canada).
  • Pekolj J; Department of General Surgery, Hepato-Pancreato-Biliary and Liver Transplant Unit, Hospital Italiano de Buenos Aires - Buenos Aires (Argentina).
  • Balzan S; Department of Life Sciences, University of Santa Cruz Do Sul, Santa Cruz do Sul - Department of Surgery, Hospital Moinhos de Vento, Porto Alegre (Brazil).
  • Fondevila C; General and Digestive Surgery, University Hospital La Paz - Madrid (Spain).
  • Han HS; Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital - Seoul (Republic of Korea).
  • Lesurtel M; Department of HPB Surgery and Liver Transplantation, Beaujon Hospital - - University of Paris Cité -Clichy (France).
  • Pinto-Marques H; Hepat-Biliary-Pancreatic and Transplantation Centre, Curry Cabral Hospital - Local Health, Unit of São José and NOVA Medical School - Lisbon (Portugal).
  • Menon K; Department of Hepatopancreatico-Biliary Surgery, King's College Hospital - London (United Kingdom).
  • Rotellar F; HPB and Liver Transplantation Unit, Department of Surgery, University Clinic, Universidad de Navarra, Institute of Health Research of Navarra (IDISNA) - Pamplona (Spain).
  • Polak WG; Department of Surgery, Division of HPB and Transplant Surgery, Erasmus Mc, University Medical Center Rotterdam - Rotterdam (Netherlands).
  • Dopazo C; Departamento de Cirugía HBP y Trasplante Hepático, Hospital Universitari Vall D´hebron, Universidad Autónoma de Barcelona - Barcelona (Spain).
  • Lopez-Ben S; Department of Surgery, Hospital Universitario Dr. Josep Trueta - Girona (Spain).
  • Torzilli G; Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital - Milan (Italy).
  • de Vicente E; Division of General Surgery, Sanchinarro Hospital, San Pablo University - Madrid (Spain).
  • de la Cruz J; Group of Applied Mathematics in Science and Engineering, Faculty of Computer Science, University of Murcia, Murcia (Spain).
  • Chavez-Villa M; Department of Liver Transplantation, University of Rochester Medical Center - Rochester (United States).
  • Ferreras D; Departement of Surgery, Hospital Universitario de Torrevieja, Alicante (Spain).
  • Serrablo A; Department of Surgery, Miguel Servet University Hospital, Zaragoza - Zaragoza (Spain).
  • De Santibañez E; Department of General Surgery, Hepato-Pancreato-Biliary and Liver Transplant Unit, Hospital Italiano de Buenos Aires - Buenos Aires (Argentina).
  • Clavien PA; University of Zurich, Swiss Medical Network, Zurich (Switzerland).
  • Azoulay D; Hepato-Biliary Center, Paul-Brousse Hospital, Paris-Saclay University - Villejuif (France).
  • Robles-Campos R; Clinic and University Virgen de la Arrixaca Hospital, IMIB-Arrixaca - Murcia (Spain).
Ann Surg ; 2024 Jun 28.
Article em En | MEDLINE | ID: mdl-38939929
ABSTRACT

OBJECTIVE:

To propose to our community a common language about extreme liver surgery.

BACKGROUND:

The lack of a clear definition of extreme liver surgery prevents convincing comparisons of results among centers.

METHODS:

We 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.

RESULTS:

A 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.

CONCLUSION:

Obtaining 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.

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Idioma: En Revista: Ann Surg Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Idioma: En Revista: Ann Surg Ano de publicação: 2024 Tipo de documento: Article