학술논문
Comparing practice and outcome of laparoscopic liver resection between high-volume expert centres and nationwide low-to-medium volume centres.
Document Type
Academic Journal
Author
Görgec B; Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands.; Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK.; Department of Surgery, Fondazione Poliambulanza - Istituto Ospedaliero, Brescia, Italy.; Fichtinger RS; Department of Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands and RWTH Aachen, Germany.; Ratti F; Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy.; Aghayan D; Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway.; The Intervention Centre, Oslo University Hospital - Rikshospitalet, Oslo, Norway.; Institute of Clinical Medicine, Medical Faculty, University of Oslo, Norway.; Van der Poel MJ; Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands.; Al-Jarrah R; Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK.; Armstrong T; Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK.; Cipriani F; Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy.; Fretland ÅA; Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway.; The Intervention Centre, Oslo University Hospital - Rikshospitalet, Oslo, Norway.; Suhool A; Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK.; Bemelmans M; Department of Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands and RWTH Aachen, Germany.; Bosscha K; Department of Surgery, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands.; Braat AE; Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands.; De Boer MT; Department of Surgery, University Medical Centre Groningen, Groningen, the Netherlands.; Dejong CHC; Department of Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands and RWTH Aachen, Germany.; Doornebosch PG; Department of Surgery, IJsselland Hospital, Capelle aan den IJssel, the Netherlands.; Draaisma WA; Department of Surgery, Meander Medical Centre, Amersfoort, the Netherlands.; Gerhards MF; Department of Surgery, OLVG, Amsterdam, the Netherlands.; Gobardhan PD; Department of Surgery, Amphia Hospital, Breda, the Netherlands.; Hagendoorn J; Department of Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands.; Kazemier G; Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands.; Klaase J; Department of Surgery, University Medical Centre Groningen, Groningen, the Netherlands.; Department of Surgery, Medical Spectrum Twente, Enschede, the Netherlands.; Leclercq WKG; Department of Surgery, Máxima Medical Centre, Veldhoven, the Netherlands.; Liem MS; Department of Surgery, Medical Spectrum Twente, Enschede, the Netherlands.; Lips DJ; Department of Surgery, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands.; Department of Surgery, Medical Spectrum Twente, Enschede, the Netherlands.; Marsman HA; Department of Surgery, OLVG, Amsterdam, the Netherlands.; Mieog JSD; Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands.; Molenaar QI; Department of Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands.; Nieuwenhuijs VB; Department of Surgery, Isala, Zwolle, the Netherlands.; Nota CL; Department of Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands.; Patijn GA; Department of Surgery, Isala, Zwolle, the Netherlands.; Rijken AM; Department of Surgery, Amphia Hospital, Breda, the Netherlands.; Slooter GD; Department of Surgery, Máxima Medical Centre, Veldhoven, the Netherlands.; Stommel MWJ; Department of Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands.; Swijnenburg RJ; Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands.; Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands.; Tanis PJ; Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands.; Te Riele WW; Department of Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands.; Terkivatan T; Department of Surgery, Erasmus Medical Centre, Rotterdam, the Netherlands.; Van den Tol PMP; Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands.; Van den Boezem PB; Department of Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands.; Van der Hoeven JA; Department of Surgery, Albert Schweitzer Hospital, Dordrecht, the Netherlands.; Vermaas M; Department of Surgery, IJsselland Hospital, Capelle aan den IJssel, the Netherlands.; Edwin B; Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway.; The Intervention Centre, Oslo University Hospital - Rikshospitalet, Oslo, Norway.; Institute of Clinical Medicine, Medical Faculty, University of Oslo, Norway.; Aldrighetti LA; Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy.; Van Dam RM; Department of Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands and RWTH Aachen, Germany.; GROW - School for Oncology & Developmental Biology, Maastricht University, Maastricht, The Netherlands.; Department of General and Visceral Surgery, University Hospital Aachen, Aachen, Germany.; Abu Hilal M; Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK.; Department of Surgery, Fondazione Poliambulanza - Istituto Ospedaliero, Brescia, Italy.; Besselink MG; Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands.
Source
Publisher: Oxford University Press on behalf of BJS Foundation Ltd Country of Publication: England NLM ID: 0372553 Publication Model: Print Cited Medium: Internet ISSN: 1365-2168 (Electronic) Linking ISSN: 00071323 NLM ISO Abbreviation: Br J Surg Subsets: MEDLINE
Subject
Language
English
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.
(© The Author(s) 2021. Published by Oxford University Press on behalf of BJS Society Ltd. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
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.
(© The Author(s) 2021. Published by Oxford University Press on behalf of BJS Society Ltd. All rights reserved. For permissions, please email: journals.permissions@oup.com.)