Background
Living donor liver transplantation is one of the most complex operations in surgery. It demands skills and dexterity as well as thorough multi-facet knowledge in physiology, anatomy, hepatology and oncology from surgeons. Since the inception of living donor liver transplantation almost three decades ago, there has been substantial improvements and refinements in the operative techniques leading to standardization of the procedure. As such, some of the transplant knowledge and skills has been extrapolated to complex liver resection(CLR) of locally advanced hepatobiliary cancer but it remained uncertain if such knowledge and skills transferal has any impact on the postoperative outcome of CLR.
Methods
Postoperative outcome after CLR between 1995 and 2019 were reviewed and correlated with LT experience in a single center with both LT and CLR service. CLR was defined as hepatectomy with vasculobiliary reconstruction, or multivisceral resection, central bisectionectomy (S4/5/8), or associating liver partition and portal vein ligation for staged hepatectomy. Spearman rank correlation and receiver operating characteristic analysis were
used to define the association between CLR-related outcomes and LT experience.
Results
With cumulative single-center experience of 1452 LT, 222 CLR were performed during the study period [hepatectomy with biliary (27.0%), or vascular (21.2%) reconstruction, with multivisceral resections (9.9%), with associating liver partition and portal vein ligation for staged hepatectomy (18.5%)] mainly for hepatocellular carcinoma (53.2%), and hilar cholangiocarcinoma (14%). Median tumor size was 7.0 cm. Other features include
macrovascular invasion (23.4%), and juxta-visceral invasion (14%). Major postoperative complication rate was 25.2% and mortality rate was 6.3%. CLR-complication rate was inversely associated with LT experience (R =0.88, P 0.005). Receiver operator characteristic analysis revealed the cutoff for LT experience to have the greatest influence on CLR was 95 with a sensitivity of 100% and Youden index of 1. Multivariable analysis showed that bloo transfusion, prolonged operating time, LT experience < /.95 were associated with major postoperative complications.
Conclusion
LT experience was complimentary to CLR for locally advanced hepatobiliary malignancy with improved postoperative outcome.
