Hepatic Resections Performed in Intermediate- to High-volume Centres in Austria – A Pilot Study of the Austrian Association of Hepato-pancreato-Biliary Surgery (AAHPBS)

Background: In 2022, the Austrian chapter of the E-AHPBA was founded (AAHPBS), aiming to promote interchange of clinical and scientific knowledge in the field of HPB diseases. As a national pilot study, liver surgery data from 2020-2022 is currently obtained from intermediate- to high-volume centres, as a basis for future projects. These results are compared to government coding data from 2020. Methods: To date, five high-volume liver surgery units were included in the current database, documenting the total number, indication for and type of liver resections, rate of minimally invasive surgery (MIS) and conversions, complications, and median length of stay (LOS). Results: Overall, 1058 liver surgeries (accounting for ⅓ of national resections) were included from 2020-2022 (36.1% major resection), of which 18.2% were performed minimally invasive, with a conversion rate of 18.9%. 29.7% of patients were diagnosed with colorectal metastases followed by 17.7% with cholangiocarcinoma. The number of patients with Clavien-Dindo grade IV and V complications were 31 (2.9%) and 28 (2.6%). The median LOS was 10 days. In 2020, on a national level 69 hospitals performed a total of 1078 liver resections (median: 9 per hospital) for about 9 million inhabitants, with an estimated 20% MIS rate. Conclusion: With inclusion of further centres, the AAHPBS network will represent a significant share of hepatobiliary resections in Austria and a fundament for future projects. The current rate of MIS, conversions and the median LOS is comparable to other European countries before nationwide structured implementation of MIS training programs.Tabled 1Table 1. Descriptive analysis of all liver surgeries performed from 2020 until 2022 in five intermediate- to high-volume centres in Austria.TotalCenter 1Center 2Center 3Center 4Center 5Total number of liver resections 2020-2022% 1058% 319% 256% 211% 138% 134Open resection77,5% 82069,0% 22098,5% 25281,5% 17247,1% 6582,8% 111Minimal invasive18,2% 19320,4% 651,5% 416,1% 3448,6% 6717,2% 23Converted4,3% 4510,7% 340,0% 02,4% 54,3% 60,0% 0Conversion rate18,9% -34,0% -0% -12,8% -8,2% -0% -Tumor entityHCC13,0% 13812,2% 3910,9% 2815,2% 3212,3% 1716,4% 22CCA117,7% 18722,6% 7216,4% 428,5% 1820,3% 2820,1% 27CRLM29,7% 31441,1% 13126,2% 6729,4% 6226,1% 3613,4% 18nCRLM14,5% 1538,5% 2718,7% 4820,4% 4315,2% 2110,4% 14Benign liver tumors216,1% 17012,5% 4011,4% 2921,3% 4517,4% 2423,9% 32Others39,1% 963,1% 1016,4% 425,2% 118,7% 1215,7% 21Major resection36,1% 38248,0% 15332,1% 8226,5% 5631,9% 4435,1% 47Minor resection63,9% 67652,0% 16669,9% 17473,5% 15568,1% 9464,9% 87ComplicationsDindo 056,4% 59750,2% 16063,3% 16251,7% 10952,9% 7369,4% 93Dindo I10,9% 11510,3% 339,3% 2417,0% 369,4% 136,7% 9Dindo II12,6% 13318,5% 5910,2% 268,5% 1815,9% 226,0% 8Dindo III14,6% 15415,0% 4812,1% 3118,5% 3914,5% 2011,9% 16Dindo IV2,9% 311,6% 54,2% 112,4% 54,3% 63,0% 4Dindo V2,6% 284,4% 140,8% 21,9% 42,9% 43,0% 4Median LOS in days (d)10d8d13d13d7d10d Open table in a new tab Hepatocellular Carcinoma (HCC), cholangiocarcinoma (CCA), colorectal liver metastases (CRLM), non-colorectal liver metastases (nCRLM). 1incl. intrahepatic CCA, distal CCA, perihilar CCA, gallbladder cancer; 2 incl. haemangioma, hepatic cyst, adenoma, FNH, echinococcosis; 3 incl. abscess, cholangitis, trauma, liver transplantation.