Journal of pediatric surgery
July 16, 2026 · via Europe PMC
Textbook outcome after hepatoblastoma resection: Definition, failure modes, and risk-adjusted benchmarking in a tertiary European center.
Fuchs J, Rabaux-Eygasier L, Hery G, Fouquet V, Pio L, Guerin F, Branchereau S.
AI summary — for doctors, generated from the abstract only
A Textbook Outcome composite for hepatoblastoma resection was achieved in 56% of children, with failures driven mainly by postoperative complications.
What was studied
A single-centre European cohort of 108 children undergoing curative-intent liver resection for hepatoblastoma, defining an all-or-none Textbook Outcome and developing a risk-adjusted benchmarking model.
Key findings
- TO-HB achieved in 60/108 (55.6%)
- Failures driven by complications (79%) and prolonged stay (38%)
- TO rates fell with higher PRETEXT stage and more extensive hepatectomy
- Observed-to-expected ratio 1.00; risk-standardised TO rate 55.6% (95% CI 42.4-71.5%)
Clinical relevance
This offers a stringent quality metric for hepatoblastoma surgery and suggests reducing postoperative morbidity as the main improvement target.
Who should care
Limitations
Single-centre data with modest sample; external validation of the benchmark across centres is needed.
About half of hepatoblastoma resections achieve a perfect perioperative course, with complications the main barrier.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Background
Textbook Outcome (TO) has emerged as a composite quality metric for benchmarking perioperative performance in adult hepatobiliary surgery. Its role in pediatric oncologic liver surgery remains insufficiently explored and TO has never been defined for hepatoblastoma resection.
Methods
Single-center cohort study including children undergoing curative-intent liver resection for hepatoblastoma. Textbook Outcome after hepatoblastoma resection (TO-HB) was defined as an all-or-none composite comprising: (i) no postoperative complications (CCI = 0), (ii) no prolonged length of stay (≤procedure-specific 75th-percentile), (iii) no reoperation within 90 days, (iv) no unplanned readmission within 90 days, and (v) no 90-day mortality. Case-mix adjustment was performed using ridge-penalized logistic regression with pre-specified covariates. Model performance was evaluated in terms of overall accuracy and calibration, including the Brier score and calibration-in-the-large, with bootstrap internal validation, to support risk-adjusted benchmarking analyses.
Results
TO-HB was achieved in 60/108 patients (55.6%). Failure to achieve TO-HB was predominantly driven by postoperative complications (38/48; 79%) and prolonged length of stay (18/48; 38%). TO-HB rates decreased with increasing surgical complexity, including higher PRETEXT stage and more extensive hepatectomy types. Risk-adjusted predictions were narrowly distributed around the overall TO rate (mean predicted probability 0.556), with preserved population-level calibration. The observed-to-expected ratio for TO-HB was 1.00, corresponding to a risk-standardized TO-HB rate of 55.6% (95% CI 42.4-71.5%).
Conclusions
TO-HB is a feasible and stringent benchmark for perioperative quality in hepatoblastoma surgery. Failure to achieve TO-HB is predominantly driven by postoperative morbidity rather than mortality or reintervention, highlighting postoperative complications as target for quality improvement.
DOI
10.1016/j.jpedsurg.2026.163308
PMID
42463005
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
Want more like this?
Browse more from the feed. A free account unlocks the full feed, saving and communities.
Back to the research feed