Textbook outcomes in liver surgery: A decade of experience at a cancer-dedicated centre.

Abstract

e16260 Background: Surgical resection is the main treatment for both primary and metastatic liver cancers, but it comes with notable risks of complications and mortality. Traditional metrics such as mortality rates, readmission rates, and length of stay (LOS) are commonly used to evaluate hospital performance, but they often do not offer a complete picture of the quality of surgical care. To address this gap, a composite "score" known as the "textbook outcome" (TO), has been developed which reflects the ideal surgical result. Achieving a TO signifies optimal care, encompassing various quality aspects throughout the patient’s treatment process. A "textbook outcome in liver surgery" (TOLS) refers to patients who undergo an ideal perioperative course after liver resection. Methods: A retrospective analysis of data for ten years, starting from 1st January 2014 to 31st December 2023. Patients who underwent liver resections for various conditions, such as hepatocellular carcinoma, intrahepatic and extrahepatic cholangiocarcinoma, primary gallbladder cancers, and metastases from other primary cancers like colorectal, gastric, pancreatic, and breast cancer were included. Additionally, liver resections for benign conditions, including large symptomatic hemangiomas and hydatid cysts, were also included. Patients with incomplete data required to define textbook outcomes were excluded, along with those who underwent multivisceral resections and pediatric age group (under 18 years). Results: The study included a total of 232 patients, with 54% being female. The average age was 52 ± 12 years, with a BMI of 27 kg/m². Most patients (55%) had an ECOG score of 0, and 89% had an ASA score of 2. At the time of presentation, 9% of the patients had jaundice. The most common reason for liver resection was metastatic disease, accounting for 42.6%, followed by hepatocellular carcinoma at 25.9%. Among the metastases, 22.4% were due to colorectal cancer. Surgery was performed via an open approach in 75% of cases, and 30% of patients underwent major liver resection. Seven key outcomes were analyzed in terms of textbook outcomes, with the most achieved outcome being no in-house or 90-day mortality, which occurred in 97% of patients. This was followed by no bile leak, no liver failure grade B/C, no intraoperative complications, negative resection margins, and no 90-day readmissions, achieved in 94%, 94%, 93%, 92.2%, and 90.5% of cases, respectively. Additionally, 89.6% of patients had Clavien-Dindo grade < 3 complications post operatively. The overall rate of TOLS was 68.1%. Conclusions: TOLS is valuable for assessing individual hospital performance and enabling international comparisons across centres with varying clinical practices, which can help improve patient outcomes. Our centre has attained textbook outcomes that are comparable with international standards, demonstrating the patient-centered care provided at our institution.