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

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.