Multicentre evaluation of case volume in minimally invasive hepatectomy

被引:19
作者
Vigano, L. [1 ]
Cimino, M. [1 ]
Aldrighetti, L. [2 ]
Ferrero, A. [5 ]
Cillo, U. [6 ]
Guglielmi, A. [7 ]
Ettorre, G. M. [8 ]
Giuliante, F. [9 ]
Dalla Valle, R. [10 ]
Mazzaferro, V. [3 ]
Jovine, E. [11 ]
De Carlis, L. [4 ]
Calise, F. [12 ]
Torzilli, G. [1 ]
机构
[1] Humanitas Univ, Res Centre,Dept Hepatobiliary,Gen Surg, Humanitas Clin, Rozzano, Italy
[2] Osped San Raffaele, Dept Surg, Milan, Italy
[3] Univ Milan, Fdn IRCCS Ist Nazl Tumori, Dept Gastrointestinal Surg, Liver Transplantat, Milan, Italy
[4] ASST Grande Osped Metropolitano Niguarda, Dept Gen Surg, Transplantat, Milan, Italy
[5] Mauriziano Umberto Hosp, Dept Digest, Hepatobiliary Surg, Turin, Italy
[6] Univ Padua, Liver Transplantat Unit, Hepatobiliary, Padua, Italy
[7] Rossi Univ Hosp, Univ Verona,Dept Surg,Div Gen,Hepatobiliary Surg, Verona, Italy
[8] San Camillo Hosp, Div Gen Surg, Liver Transplantat, Rome, Italy
[9] Univ Cattolica Sacro Cuore, Gemelli Hosp, Hepatobiliary Surg Unit, Rome, Italy
[10] Univ Hosp Parma, Dept Surg, Parma, Italy
[11] Maggiore Hosp, Dept Surg, Bologna, Italy
[12] Pinetagrande Hosp, Dept Hepatopancreatobiliary Surg, Castelvolturno, Italy
关键词
LAPAROSCOPIC LIVER RESECTION; HEPATOCELLULAR-CARCINOMA; SURGERY; OUTCOMES; METASTASES; DIFFICULTY; PROPOSAL;
D O I
10.1002/bjs.11369
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background Surgical outcomes may be associated with hospital volume and the influence of volume on minimally invasive liver surgery (MILS) is not known. Methods Patients entered into the prospective registry of the Italian Group of MILS from 2014 to 2018 were considered. Only centres with an accrual period of at least 12 months and stable MILS activity during the enrolment period were included. Case volume was defined by the mean number of minimally invasive liver resections performed per month (MILS/month). Results A total of 2225 MILS operations were undertaken by 46 centres; nine centres performed more than two MILS/month (1376 patients) and 37 centres carried out two or fewer MILS/month (849 patients). The proportion of resections of anterolateral segments decreased with case volume, whereas that of major hepatectomies increased. Left lateral sectionectomies and resections of anterolateral segments had similar outcome in the two groups. Resections of posterosuperior segments and major hepatectomies had higher overall and severe morbidity rates in centres performing two or fewer MILS/month than in those undertaking a larger number (posterosuperior segments resections: overall morbidity 30 center dot 4 versus 18 center dot 7 per cent respectively, and severe morbidity 9 center dot 9 versus 4 center dot 0 per cent; left hepatectomy: 46 versus 22 per cent, and 19 versus 5 per cent; right hepatectomy: 42 versus 34 per cent, and 25 versus 15 per cent). Conclusion A volume-outcome association existed for minimally invasive hepatectomy. Complex and major resections may be best managed in high-volume centres.
引用
收藏
页码:443 / 451
页数:9
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