Comparing practice and outcome of laparoscopic liver resection between high-volume expert centres and nationwide low-to-medium volume centres. Issue 8 (1st July 2021)

• Record Type: Journal Article
• Authors: Görgec, B; Fichtinger, R S; Ratti, F; Aghayan, D; Van der Poel, M J; Al-Jarrah, R; Armstrong, T; Cipriani, F; Fretland, Å A; Suhool, A; Bemelmans, M; Bosscha, K; Braat, A E; De Boer, M T; Dejong, C H C; Doornebosch, P G; Draaisma, W A; Gerhards, M F; Gobardhan, P D; Hagendoorn, J; Kazemier, G; Klaase, J; Leclercq, W K G; Liem, M S; Lips, D J; Marsman, H A; Mieog, J S D; Molenaar, Q I; Nieuwenhuijs, V B; Nota, C L; Patijn, G A; Rijken, A M; Slooter, G D; Stommel, M W J; Swijnenburg, R J; Tanis, P J; Te Riele, W W; Terkivatan, T; Van den Tol, P M P; Van den Boezem, P B; Van der Hoeven, J A; Vermaas, M; Edwin, B; Aldrighetti, L A; Van Dam, R M; Abu Hilal, M; Besselink, M G;
• Is Part Of: British journal of surgery. Volume 108:Issue 8(2021)
• Page Start: 983
• Page End: 990
• Publication Date: 2021-07-01
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1093/bjs/znab096
• Languages: English
• ISSNs: 0007-1323

Abstract

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. Abstract : 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.