Publication date: Mar 24, 2025

This study aimed to investigate the effects of the coronavirus disease 2019 pandemic on morbidity and mortality after advanced hepatectomy by surgical volume in Japan. Data from patients who underwent advanced hepatectomy between 2018 and 2022 from the Japanese National Clinical Database were collected. The transition of the number of hepatectomies and changes in risk-adjusted mortality and major complication rates based on the type of institutions certified by the Japan Society of Hepato-Biliary-Pancreatic Surgery were investigated. A total of 33 454 cases were included. The number of advanced hepatectomies gradually decreased, whereas the proportion of hepatectomies performed in certified institutions increased (from 63. 4% in 2018 to 71. 3% in 2022). Although the major complication rate in institution A was higher than that in institution B or noncertified institutions (16. 3% vs. 14. 5% vs. 13. 5%), the in-hospital mortality rate was consistently favorable in the order of institution A, institution B, and noncertified institutions (1. 4% vs. 2. 0% vs. 2. 8%). The monthly standardized mortality and major complication ratios did not significantly increase mostly throughout the pandemic, regardless of the institution type. The centralization to certified institutions progressed even during the pandemic. Surgical safety after advanced hepatectomy was satisfactorily maintained in any institution.

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