• Luca Viganò, Guido Torzilli, Luca Aldrighetti, Alessandro Ferrero, Roberto Troisi, Joan Figueras, Daniel Cherqui, René Adam, Norihiro Kokudo, Kiyoshi Hasegawa, Alfredo Guglielmi, Pietro Majno, Christian Toso, Marek Krawczyk, Mohammad Abu Hilal, Antonio Daniele Pinna, Matteo Cescon, Felice Giuliante, Eduardo De Santibanes, José Costa-Maia, Timothy Pawlik, Lucio Urbani, Daniela Zugna, and CLISCO group.
• Division of Hepatobiliary and General Surgery, Department of Surgery, Humanitas Clinical and Research Center - IRCCS, Rozzano - Milan, Italy.
• Ann. Surg. 2020 Nov 1; 272 (5): 827-833.

ObjectiveTo stratify major hepatectomies (MajHs) according to their outcomes.Summary Of Background DataMajHs are associated with non-negligible operative risks, but they include a wide range of procedures. Detailed depiction of the outcomes of different MajHs is the basis for a new classification of liver resections.MethodsWe retrospectively considered patients that underwent hepatectomy in 17 high-volume centers. Patients with an associated digestive/biliary resection were excluded. We analyzed open MajHs in non-cirrhotic patients. MajHs were classified according to the Brisbane nomenclature. Right hepatectomies (RHs) were reference standards. Outcomes were adjusted for potential confounders, including indication, liver function, preoperative portal vein embolization, and enrolling center.ResultsWe analyzed a series of 2212 patients. In comparison with RH, left hepatectomy had lower mortality [0.6% vs 2.2%, odds ratio (OR) = 0.25], severe morbidity (11.7% vs 14.4%, OR = 0.62), and liver failure rates (2.1% vs 11.6%, OR = 0.16). Left hepatectomy+Sg1 and mesohepatectomy+/-Sg1 had outcomes similar to RH, except for higher bile leak rate (31.3% and 13.5% vs 6.7%, OR = 4.36 and OR = 2.29). RH + Sg1 had slightly worse outcomes than RH. Right and left trisectionectomies had higher mortality (5.0% and 7.3% vs 2.2%, OR = 2.07 and OR = 2.71) and liver failure rates than RH (19.0% and 22.0% vs 11.6%, OR = 2.03 and OR = 2.21). Left trisectionectomy had even higher severe morbidity (25.6% vs 14.4%, OR = 2.07) and bile leak rates (14.6% vs 6.7%, OR = 2.31).ConclusionsThe term "major hepatectomy" includes resections having heterogeneous outcome. Different MajHs can be stratified according to their mortality, severe morbidity, liver failure, and bile leak rates.

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