1. Headquarters | Royal Free London NHS Foundation Trust | UK
International Liver Surgery Outcomes Study
Dimitri Raptis:
LiverGroup.org Collaborative
Headquarters | Royal Free London NHS Foundation Trust | UK

2. Headquarters | Royal Free London NHS Foundation Trust | UK
International Liver Surgery Outcomes Study
Mortality after major liver resection is claimed to have improved (1-2%).
However, epidemiological studies show mortality rates of up to 6%.
Outcome in liver surgery is influenced by:
Indications ranging from colorectal liver metastases to cholangiocarcinoma.
Complexity ranging from wedge resections to two-stage hepatectomy and trisectionectomy with biliary reconstruction and reopertive surgery.
Skills/equipment ranging from single general surgeon private practice to hepatobiliary/transplant centers.
Headquarters | Royal Free London NHS Foundation Trust | UK

3. Headquarters | Royal Free London NHS Foundation Trust | UK
International Liver Surgery Outcomes Study
Outcomes of liver surgery are not reported in a uniform way:
Morbidity and mortality reported at hospital discharge, 30 or 90 days
Morbidity reported as minor vs. major, severe, Clavien-Dindo, CCI
Underreported in registries and retrospective studies
Patient selection in RCT
Headquarters | Royal Free London NHS Foundation Trust | UK

4. Headquarters | Royal Free London NHS Foundation Trust | UK
International Liver Surgery Outcomes Study
Primary objective: Provide a verified record of the true perioperative morbidity and mortality rates of a representative set of liver surgeons in 2019 worldwide.
Secondary objectives: Identify modifiable risk factors for morbidity and mortality using multivariable models.
Headquarters | Royal Free London NHS Foundation Trust | UK

5. Headquarters | Royal Free London NHS Foundation Trust | UK
International Liver Surgery Outcomes Study
”Snapshot” collaborative study:
3 month data collection
3 month postoperative follow up
within a 1 year frame period (2019)
Registration open to any individual surgeon performing liver resections
May require local ethics approval (country- or center-dependent)
Data entry requires approximately 15 minutes per patient
Several tools regarding classifications, volume assessment, etc. available on the website
Headquarters | Royal Free London NHS Foundation Trust | UK

6. 5 study principles International Liver Surgery Outcomes Study
Principle of surgeon responsibility
Surgeons are recording their patients, not centers
principle of audit
random peer audit of outcomes of at least 30% of collaborators for data quality control 
5 study principles
Principle of consecutivity
All consecutive patients operated
should be entered
Principle of intent to treat
Patients not treated according to the plan prior to surgery should be entered
Principle of surgeon collaborators: surgeons are recording their patients, not centers
Principle of consecutivity: all consecutive patients operated should be entered
Principle of intent-to-treat: patients not treated according to the plan prior to surgery should be entered
Principle of audit: random peer audit of outcomes of at least 30% of collaborators for data quality control 
Principle of collaborative authorship: collaborating authorship of all contributors
Principle of collaborative authorship
Authorship for all contributors
Headquarters | Royal Free London NHS Foundation Trust | UK

7. LiverGroup.org Collaborative
International Liver Surgery Outcomes Study
”Snapshot" study on liver surgery worldwide over 3 months
Provide a verified record of true morbidity and mortality
Identify risk factors of outcome after lifer surgery
Study period January to December 2019
LiverGroup.org Collaborative
Headquarters | Royal Free London NHS Foundation Trust | UK