| 1. Where is your center located? (Figure 1) |
| 2. Your institution offers: |
| - State funded health care: |
9 (20.9%) |
| - Private health care |
10 (23.3%) |
| - State funded and private health care: |
24 (55.8%) |
| 3. How many surgeons perform liver resections in your team? |
| - Mean: 3.37 (minimum: 1/ maximum: 6/ standard deviation: 1.33) |
| 4. Does your team have residency/fellowship programs? (Figure 2A) |
| - Yes: |
37 (86%) |
| - No: |
6 (14%) |
| 5. Does your team also perform liver transplantation? |
| - Yes: |
21 (48.8%) |
| - No: |
22 (51.2%) |
| 6. How many liver resections are performed per year in your center? (Figure 2B) |
| - >15: |
6 (14%) |
| - 16-30: |
15 (34.8%) |
| - 31-50: |
15 (34.8%) |
| - 51-80: |
6 (14%) |
| - 81-100: |
0 (0%) |
| - >100: |
1 (2.3%) |
| 7. What is the percentage of laparoscopic liver resections related to overall procedures? (Figure 2C) |
| - 0%: |
4 (9.3%) |
| - 1-9%: |
17 (39.5%) |
| - 10-19%: |
10 (23.3%) |
| - 20-39%: |
6 (14%) |
| - 40-49%: |
5 (11.6%) |
| - >50%: |
1 (2.3%) |
| 8. What is the main indication for liver resection in your institution? |
| - Malignant primary tumours: |
6 (14.3%) |
| - Benign tumours: |
1 (2.4%) |
| - Liver metastases: |
35 (83.3%) |
| 9. What is the percentage of major hepatectomy? |
| - 1-10%: |
0 (0%) |
| - 11-20%: |
5 (11.9%) |
| - 21-40%: |
15 (35.7%) |
| - 41-50%: |
17 (40.5%) |
| - >50%: |
5 (11.9%) |
| 10. What is the preferred incision for major hepatectomy? |
| - Midline incision: |
0 (0%) |
| - “J” incision: |
27 (64.3) |
| - “Mercedes” incision: |
5 (11.9%) |
| - Transverse incision: |
0 (0%) |
| - Bilateral subcostal incision: |
10 (23.8%) |
| - Long midline incision with transverse extension: |
0 (0%) |
| - Other incisions: |
0 (0%) |
| 11. Do you use Pringle maneuver: |
| - Routinely: |
2 (4.8%) |
| - Selective: |
37 (88.1%) |
| - Never: |
3 (7.1%) |
| 12. Do you use Pringle maneuver in major hepatectomy: |
| - Routinely: |
11 (26.2%) |
| - Selective: |
29 (69%) |
| - Never: |
2 (4.8%) |
| 13. How is your preferred approach to hepatic pedicle? |
| - Dissection of all structures: |
17 (40.5%) |
| - Extrahepatic Glissonian approach: |
9 (21.4%) |
| - Intrahepatic Glissonian approach: |
7 (16.7%) |
| - Pedicle clamping (Pringle/ Hemi-Pringle) plus approach during parenchyma transection: |
8 (19%) |
| - Other: |
1 (2.4%) |
| 14. What is your preferred method for parenchyma transection in OPEN surgeries? |
| - Ultrasonic surgical aspirator: |
14 (33.3%) |
| - Kelly clamp crushing: |
10 (23.8%) |
| - Energy disposable devices (p.e. harmonic scalpel or advanced bipolar vessel sealing): |
8 (19%) |
| - Water-jet dissection: |
1 (2.4%) |
| - Bipolar cautery: |
6 (14.3%) |
| - Silkclasy: |
2 (4.8%) |
| - Digitoclasy: |
0 (0%) |
| - Stapler: |
0 (0%) |
| - Other: |
1 (2.4%) |
| 15. What is your preferred method for parenchyma transection in LAPAROSCOPIC surgeries? |
| - Ultrasonic surgical aspirator: |
4 (9.5%) |
| - Stapler: |
3 (7.1%) |
| - Harmonic scalpel: |
17 (40.5%) |
| - Advanced bipolar energy: |
13 (31%) |
| - Other: |
1 (2.4%) |
| - We do not perform laparoscopic resections: |
4 (9.5%) |
| 16. Do you have intraoperative ultrasound available? |
| - Yes, for open procedures: |
32 (76.2%) |
| - Yes, for open and laparoscopic procedures: |
7 (16.7%) |
| - No: |
3 (7.1%) |
| 17. Do you use routinely drain in major hepatectomies? |
| - Yes: |
38 (90.5%) |
| - No: |
4 (9.5%) |
| 18. If you routinely use drain in major hepatectomies, what is your preferred drain? |
| - Closed tubular in aspiration (i.e. Blake, Jackson-Pratt): |
33 (78.6%) |
| - Open tubular and laminar (i.e. Waterman): |
2 (4.8%) |
| - Open laminar (i.e. Penrose): |
4 (9.5%) |
| - Open tubular: |
3 (7.1%) |
| 19. Do you apply routinely haemostatics or sealants on the raw surface area after hepatectomy? |
| - No: |
27 (64.3%) |
| - Yes, fibrin glue: |
7 (16.7%) |
| - Yes, topic haemostatic (sponges, plaque, mesh): |
8 (19%) |
| 20. Do you perform intraoperative test for biliary leakage after major hepatectomies? |
| - Always: |
13 (31%) |
| - In selected cases: |
19 (45.2%) |
| - Never: |
10 (23.8%) |
| 21. What is your incidence of postoperative biliary leakage? |
| - <10%: |
33 (78.6%) |
| - 10-19%: |
9 (21.4%) |
| - 20-29%: |
0 (0%) |
| - >30% |
0 (0%) |
| 22. What is you intraoperative blood transfusion rate? |
| - < 10%: |
23 (54.8%) |
| - 10-19%: |
11 (26.2%) |
| - 20-29%: |
3 (7.1%) |
| - 30-39%: |
4 (9.5%) |
| - 40-49%: |
0 (0%) |
| - >50%: |
1 (2.4%) |
| 23. What is your postoperative morbidity rate? |
| - <10%: |
10 (23.8%) |
| - 10-19%: |
18 (42.8%) |
| - 20-29%: |
7 (16.7%) |
| - 30-39%: |
5 (11.9%) |
| - 40-49%: |
2 (4.8%) |
| - >50%: |
0 (0%) |
| 24. What is your postoperative mortality rate? (Figure 2D) |
| - <1%: |
5 (11.9%) |
| - 1-3%: |
23 (54.8%) |
| - 4-6%: |
9 (21.4%) |
| - 7-10%: |
5 (11.9%) |
| - >10%: |
0 (0%) |
| 25. Do you have percutaneous biliary drainage available in your hospital? |
| - Yes: |
38 (90.5%) |
| - No: |
4 (9.5%) |
| 26. Do you have portal embolization available in your hospital? |
| - Yes: |
37 (88.1%) |
| - No: |
5 (11.9%) |
| 27. Do you have transarterial chemoembolization available in your hospital? |
| - Yes: |
33 (78.6%) |
| - No: |
9 (21.4%) |
| 28. Do you have endoscopic retrograde cholangiopancreatography available in your hospital? |
| - Yes: |
41 (97.6%) |
| - No: |
1 (2.4%) |
LIVER RESECTION IN BRAZIL: A NATIONAL SURVEY
Note: Number of centers in each city is between brackets
