B Görgec1,2,3, R S Fichtinger4, F Ratti5, D Aghayan6,7,8, M J Van der Poel1, R Al-Jarrah2, T Armstrong2, F Cipriani5, Å A Fretland6,7, A Suhool2, M Bemelmans4, K Bosscha9, A E Braat10, M T De Boer11, C H C Dejong4, P G Doornebosch12, W A Draaisma13, M F Gerhards14, P D Gobardhan15, J Hagendoorn16, G Kazemier17, J Klaase11,18, W K G Leclercq19, M S Liem18, D J Lips9,18, H A Marsman14, J S D Mieog10, Q I Molenaar16, V B Nieuwenhuijs20, C L Nota16, G A Patijn20, A M Rijken15, G D Slooter19, M W J Stommel21, R J Swijnenburg1,10, P J Tanis1, W W Te Riele22, T Terkivatan23, P M P Van den Tol17, P B Van den Boezem21, J A Van der Hoeven24, M Vermaas12, B Edwin6,7,8, L A Aldrighetti5, R M Van Dam4,25,26, M Abu Hilal2,3, M G Besselink1. 1. Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands. 2. Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK. 3. Department of Surgery, Fondazione Poliambulanza - Istituto Ospedaliero, Brescia, Italy. 4. Department of Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands and RWTH Aachen, Germany. 5. Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy. 6. Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway. 7. The Intervention Centre, Oslo University Hospital - Rikshospitalet, Oslo, Norway. 8. Institute of Clinical Medicine, Medical Faculty, University of Oslo, Norway. 9. Department of Surgery, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands. 10. Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands. 11. Department of Surgery, University Medical Centre Groningen, Groningen, the Netherlands. 12. Department of Surgery, IJsselland Hospital, Capelle aan den IJssel, the Netherlands. 13. Department of Surgery, Meander Medical Centre, Amersfoort, the Netherlands. 14. Department of Surgery, OLVG, Amsterdam, the Netherlands. 15. Department of Surgery, Amphia Hospital, Breda, the Netherlands. 16. Department of Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands. 17. Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands. 18. Department of Surgery, Medical Spectrum Twente, Enschede, the Netherlands. 19. Department of Surgery, Máxima Medical Centre, Veldhoven, the Netherlands. 20. Department of Surgery, Isala, Zwolle, the Netherlands. 21. Department of Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands. 22. Department of Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands. 23. Department of Surgery, Erasmus Medical Centre, Rotterdam, the Netherlands. 24. Department of Surgery, Albert Schweitzer Hospital, Dordrecht, the Netherlands. 25. GROW - School for Oncology & Developmental Biology, Maastricht University, Maastricht, The Netherlands. 26. Department of General and Visceral Surgery, University Hospital Aachen, Aachen, Germany.
Abstract
BACKGROUND: Based on excellent outcomes from high-volume centres, laparoscopic liver resection is increasingly being adopted into nationwide practice which typically includes low-medium volume centres. It is unknown how the use and outcome of laparoscopic liver resection compare between high-volume centres and low-medium volume centres. This study aimed to compare use and outcome of laparoscopic liver resection in three leading European high-volume centres and nationwide practice in the Netherlands. METHOD: An international, retrospective multicentre cohort study including data from three European high-volume centres (Oslo, Southampton and Milan) and all 20 centres in the Netherlands performing laparoscopic liver resection (low-medium volume practice) from January 2011 to December 2016. A high-volume centre is defined as a centre performing >50 laparoscopic liver resections per year. Patients were retrospectively stratified into low, moderate- and high-risk Southampton difficulty score groups. RESULTS: A total of 2425 patients were included (1540 high-volume; 885 low-medium volume). The median annual proportion of laparoscopic liver resection was 42.9 per cent in high-volume centres and 7.2 per cent in low-medium volume centres. Patients in the high-volume centres had a lower conversion rate (7.4 versus 13.1 per cent; P < 0.001) with less intraoperative incidents (9.3 versus 14.6 per cent; P = 0.002) as compared to low-medium volume centres. Whereas postoperative morbidity and mortality rates were similar in the two groups, a lower reintervention rate (5.1 versus 7.2 per cent; P = 0.034) and a shorter postoperative hospital stay (3 versus 5 days; P < 0.001) were observed in the high-volume centres as compared to the low-medium volume centres. In each Southampton difficulty score group, the conversion rate was lower and hospital stay shorter in high-volume centres. The rate of intraoperative incidents did not differ in the low-risk group, whilst in the moderate-risk and high-risk groups this rate was lower in high-volume centres (absolute difference 6.7 and 14.2 per cent; all P < 0.004). CONCLUSION: High-volume expert centres had a sixfold higher use of laparoscopic liver resection, less conversions, and shorter hospital stay, as compared to a nationwide low-medium volume practice. Stratification into Southampton difficulty score risk groups identified some differences but largely outcomes appeared better for high-volume centres in each risk group.
BACKGROUND: Based on excellent outcomes from high-volume centres, laparoscopic liver resection is increasingly being adopted into nationwide practice which typically includes low-medium volume centres. It is unknown how the use and outcome of laparoscopic liver resection compare between high-volume centres and low-medium volume centres. This study aimed to compare use and outcome of laparoscopic liver resection in three leading European high-volume centres and nationwide practice in the Netherlands. METHOD: An international, retrospective multicentre cohort study including data from three European high-volume centres (Oslo, Southampton and Milan) and all 20 centres in the Netherlands performing laparoscopic liver resection (low-medium volume practice) from January 2011 to December 2016. A high-volume centre is defined as a centre performing >50 laparoscopic liver resections per year. Patients were retrospectively stratified into low, moderate- and high-risk Southampton difficulty score groups. RESULTS: A total of 2425 patients were included (1540 high-volume; 885 low-medium volume). The median annual proportion of laparoscopic liver resection was 42.9 per cent in high-volume centres and 7.2 per cent in low-medium volume centres. Patients in the high-volume centres had a lower conversion rate (7.4 versus 13.1 per cent; P < 0.001) with less intraoperative incidents (9.3 versus 14.6 per cent; P = 0.002) as compared to low-medium volume centres. Whereas postoperative morbidity and mortality rates were similar in the two groups, a lower reintervention rate (5.1 versus 7.2 per cent; P = 0.034) and a shorter postoperative hospital stay (3 versus 5 days; P < 0.001) were observed in the high-volume centres as compared to the low-medium volume centres. In each Southampton difficulty score group, the conversion rate was lower and hospital stay shorter in high-volume centres. The rate of intraoperative incidents did not differ in the low-risk group, whilst in the moderate-risk and high-risk groups this rate was lower in high-volume centres (absolute difference 6.7 and 14.2 per cent; all P < 0.004). CONCLUSION: High-volume expert centres had a sixfold higher use of laparoscopic liver resection, less conversions, and shorter hospital stay, as compared to a nationwide low-medium volume practice. Stratification into Southampton difficulty score risk groups identified some differences but largely outcomes appeared better for high-volume centres in each risk group.
Authors: Rebecca Marino; Pim B Olthof; Hong J Shi; Khe T C Tran; Jan N M Ijzermans; Türkan Terkivatan Journal: World J Surg Date: 2022-09-26 Impact factor: 3.282