Surgical Volume and Short-Term Outcomes After Advanced Hepatectomy in the Postpandemic Era: Analysis of the Japanese National Clinical Database (2018-2023).

Aim: Previous studies have shown that the volume and short-term outcomes of advanced hepatectomy in Japan remained stable during the coronavirus disease 2019 (COVID-19) pandemic. However, whether these trends have changed in the postpandemic period remains unclear. This study aimed to evaluate surgical volume and short-term outcomes following advanced hepatectomy in Japan during the postpandemic era. Methods: Data from the Japanese National Clinical Database (NCD) were analyzed for patients who underwent advanced hepatectomy between 2018 and 2023. Changes in the number of the procedures, major complications (Clavien-Dindo grade ≥ III), 30-day and inhospital mortality rates, and failure-to-rescue rates were assessed. The standardized morbidity and mortality ratios-calculated as the observed-to-expected incidence rates using an NCD-established risk model for 30-day mortality, inhospital mortality, and major complications-were also examined. Results: A total of 39 348 cases were included. The number of advanced hepatectomies showed a gradual decline, independent of the COVID-19 pandemic. However, the proportion of patients aged over 80 years significantly increased throughout the study period. Monthly standardized mortality and morbidity ratios largely remained stable across the study period, including during the pandemic and postpandemic eras. Conclusions: Analysis of data from a nationwide Japanese database indicates that advanced hepatectomy continues to be performed safely in the post-COVID-19 era, despite a decreasing procedural volume.