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Updated: Jul 16, 2026

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Harmonizing Definitions and Perspectives in Extreme Liver Surgery: A Delphi Experts Consensus.

Victor Lopez-Lopez1, Peter Lodge2, Karl Oldhafer3,4

  • 1Clinic and University Virgen de la Arrixaca Hospital, IMIB-Arrixaca, Murcia, Spain.

Annals of Surgery
|June 28, 2024
PubMed
Summary

Experts reached a consensus on defining extreme liver surgery, establishing a common language for complex hepatobiliary oncological disease. This standardized definition is crucial for comparing results and improving patient management in liver surgery.

Keywords:
consensusliver surgeryliver transplantationvascular resection

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Area of Science:

  • Hepatobiliary Surgery
  • Surgical Oncology
  • Medical Consensus

Background:

  • Lack of a standardized definition for extreme liver surgery hinders comparative analysis of outcomes across different surgical centers.
  • Establishing a common language is essential for consistent reporting and evaluation of complex liver resections.

Purpose of the Study:

  • To develop a universally accepted definition for extreme liver surgery.
  • To establish a common terminology for complex hepatobiliary procedures.

Main Methods:

  • A two-round Delphi methodology was employed, involving 38 expert surgeons in complex hepatobiliary surgery.
  • Consensus was defined as over 70% positive responses (agree/totally agree) on proposed definitions.
  • A five-point Likert scale was used, with results presented numerically and as percentages.

Main Results:

  • High agreement was achieved for definitions of total vascular occlusion (97%), hepatic flow occlusion (81%), and inferior vein occlusion (84%).
  • The 'in situ' approach was preferred for liver surgery (64%).
  • Autologous or cadaveric grafts were recommended for hepatic artery/vein repair (89%), with 75% overall agreement on the extreme liver surgery definition.

Conclusions:

  • A consensus definition for extreme liver surgery is vital for the effective management of patients with complex hepatobiliary oncological conditions.
  • Comprehensive patient care, including selection and surgical strategy, is paramount for candidates undergoing extreme liver surgery.