Outcomes of elective liver surgery worldwide: a global, prospective, multicenter, cross-sectional study

Background: The outcomes of liver surgery worldwide remain unknown. The true population-based outcomes are likely different to those vastly reported that reflect the activity of highly specialized academic centers. The aim of this study was to measure the true worldwide practice of liver surgery and associated outcomes by recruiting from centers across the globe. The geographic distribution of liver surgery activity and complexity was also evaluated to further understand variations in outcomes. Methods: LiverGroup.org was an international, prospective, multicenter, cross-sectional study following the Global Surgery Collaborative Snapshot Research approach with a 3-month prospective, consecutive patient enrollment within January–December 2019. Each patient was followed up for 90 days postoperatively. All patients undergoing liver surgery at their respective centers were eligible for study inclusion. Basic demographics, patient and operation characteristics were collected. Morbidity was recorded according to the Clavien–Dindo Classification of Surgical Complications. Country-based and hospital-based data were collected, including the Human Development Index (HDI). (NCT03768141). Results: A total of 2159 patients were included from six continents. Surgery was performed for cancer in 1785 (83%) patients. Of all patients, 912 (42%) experienced a postoperative complication of any severity, while the major complication rate was 16% (341/2159). The overall 90-day mortality rate after liver surgery was 3.8% (82/2,159). The overall failure to rescue rate was 11% (82/ 722) ranging from 5 to 35% among the higher and lower HDI groups, respectively. Conclusions: This is the first to our knowledge global surgery study specifically designed and conducted for specialized liver surgery. The authors identified failure to rescue as a significant potentially modifiable factor for mortality after liver surgery, mostly related to lower Human Development Index countries. Members of the LiverGroup.org network could now work together to develop quality improvement collaboratives

Abdominal Sarcoidosis Mimicking Pancreatic Adenocarcinoma

Sarcoidosis is a chronic, granulomatous, autoinflammatory disease that affects different parts of the body. Pulmonary manifestations are described in the majority of cases, with pancreatic involvement being &lt;1-5%. The initial reports of pancreatic sarcoidosis were detected on autopsy. A review of the literature revealed that the majority of patients with pancreatic sarcoidosis initially presented with a clinical presentation identical to pancreatic malignancy. We describe the case of a male with a history of chronic pancreatitis and alcoholism who underwent pancreaticoduodenectomy given the concern for pancreatic denocarcinoma, and was found to have isolated pancreatic sarcoidosis. This case illustrates the difficulty in diagnosing the etiology of pancreatic masses pre-operatively leading to the majority of cases getting definitive diagnosis after operative exploration. We suggest that there needs to be further delineation of this disease process in order to determine the best treatment options for patients presenting with pancreatic disease. </jats:p