Comparing practice and outcome of laparoscopic liver resection between high-volume expert centres and nationwide low-to-medium volume centres

B. Görgec; R. S. Fichtinger; F. Ratti; D. Aghayan; M. J. Van der Poel; R. Al-Jarrah; T. Armstrong; F. Cipriani; ÅA Fretland; A. Suhool; M. Bemelmans; K. Bosscha; A. E. Braat; M. T. De Boer; C. H.C. Dejong; P. G. Doornebosch; W. A. Draaisma; M. F. Gerhards; P. D. Gobardhan; J. Hagendoorn; G. Kazemier; J. Klaase; W. K.G. Leclercq; M. S. Liem; D. J. Lips; H. A. Marsman; J. S.D. Mieog; Q. I. Molenaar; V. B. Nieuwenhuijs; C. L. Nota; G. A. Patijn; A. M. Rijken; G. D. Slooter; M. W.J. Stommel; R. J. Swijnenburg; P. J. Tanis; W. W. Te Riele; T. Terkivatan; P. M.P. Van den Tol; P. B. Van den Boezem; J. A. Van der Hoeven; M. Vermaas; B. Edwin; L. A. Aldrighetti; R. M. Van Dam; M. Abu Hilal; M. G. Besselink

doi:10.1093/bjs/znab096

Comparing practice and outcome of laparoscopic liver resection between high-volume expert centres and nationwide low-to-medium volume centres

B. Görgec, R. S. Fichtinger, F. Ratti, D. Aghayan, M. J. Van der Poel, R. Al-Jarrah, T. Armstrong, F. Cipriani, ÅA Fretland, A. Suhool, M. Bemelmans, K. Bosscha, A. E. Braat, M. T. De Boer, C. H.C. Dejong, P. G. Doornebosch, W. A. Draaisma, M. F. Gerhards, P. D. Gobardhan, J. HagendoornG. Kazemier, J. Klaase, W. K.G. Leclercq, M. S. Liem, D. J. Lips, H. A. Marsman, J. S.D. Mieog, Q. I. Molenaar, V. B. Nieuwenhuijs, C. L. Nota, G. A. Patijn, A. M. Rijken, G. D. Slooter, M. W.J. Stommel, R. J. Swijnenburg, P. J. Tanis, W. W. Te Riele, T. Terkivatan, P. M.P. Van den Tol, P. B. Van den Boezem, J. A. Van der Hoeven, M. Vermaas, B. Edwin, L. A. Aldrighetti, R. M. Van Dam, M. Abu Hilal, M. G. Besselink

Research output: Contribution to journal › Article › Academic › peer-review

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.

Original language	English
Pages (from-to)	983-990
Number of pages	8
Journal	The British journal of surgery
Volume	108
Issue number	8
DOIs	https://doi.org/10.1093/bjs/znab096
Publication status	Published - 19 Aug 2021

Keywords

Aged
Carcinoma, Hepatocellular/surgery
Female
Follow-Up Studies
Hepatectomy/methods
Hospitals, High-Volume/statistics & numerical data
Humans
Incidence
Laparoscopy/methods
Liver Neoplasms/surgery
Male
Middle Aged
Netherlands/epidemiology
Postoperative Complications/epidemiology
Propensity Score
Retrospective Studies
Risk Factors

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10.1093/bjs/znab096

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Görgec, B., Fichtinger, R. S., Ratti, F., Aghayan, D., Van der Poel, M. J., Al-Jarrah, R., Armstrong, T., Cipriani, F., Fretland, ÅA., 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., ... Besselink, M. G. (2021). Comparing practice and outcome of laparoscopic liver resection between high-volume expert centres and nationwide low-to-medium volume centres. The British journal of surgery, 108(8), 983-990. https://doi.org/10.1093/bjs/znab096

@article{c9c5af4079484786a3899163b88a7146,

title = "Comparing practice and outcome of laparoscopic liver resection between high-volume expert centres and nationwide low-to-medium volume centres",

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.",

keywords = "Aged, Carcinoma, Hepatocellular/surgery, Female, Follow-Up Studies, Hepatectomy/methods, Hospitals, High-Volume/statistics & numerical data, Humans, Incidence, Laparoscopy/methods, Liver Neoplasms/surgery, Male, Middle Aged, Netherlands/epidemiology, Postoperative Complications/epidemiology, Propensity Score, Retrospective Studies, Risk Factors",

author = "B. G{\"o}rgec and Fichtinger, {R. S.} and F. Ratti and D. Aghayan and {Van der Poel}, {M. J.} and R. Al-Jarrah and T. Armstrong and F. Cipriani and {\AA}A Fretland and A. Suhool and M. Bemelmans and K. Bosscha and Braat, {A. E.} and {De Boer}, {M. T.} and Dejong, {C. H.C.} and Doornebosch, {P. G.} and Draaisma, {W. A.} and Gerhards, {M. F.} and Gobardhan, {P. D.} and J. Hagendoorn and G. Kazemier and J. Klaase and Leclercq, {W. K.G.} and Liem, {M. S.} and Lips, {D. J.} and Marsman, {H. A.} and Mieog, {J. S.D.} and Molenaar, {Q. I.} and Nieuwenhuijs, {V. B.} and Nota, {C. L.} and Patijn, {G. A.} and Rijken, {A. M.} and Slooter, {G. D.} and Stommel, {M. W.J.} and Swijnenburg, {R. J.} and Tanis, {P. J.} and {Te Riele}, {W. W.} and T. Terkivatan and {Van den Tol}, {P. M.P.} and {Van den Boezem}, {P. B.} and {Van der Hoeven}, {J. A.} and M. Vermaas and B. Edwin and Aldrighetti, {L. A.} and {Van Dam}, {R. M.} and {Abu Hilal}, M. and Besselink, {M. G.}",

note = "Publisher Copyright: {\textcopyright} 2021 The Author(s) 2021. Published by Oxford University Press on behalf of BJS Society Ltd. All rights reserved. For permissions, please email: [email protected].",

year = "2021",

month = aug,

day = "19",

doi = "10.1093/bjs/znab096",

language = "English",

volume = "108",

pages = "983--990",

journal = "The British journal of surgery",

issn = "1365-2168",

publisher = "John Wiley & Sons Inc.",

number = "8",

}

Görgec, B, Fichtinger, RS, Ratti, F, Aghayan, D, Van der Poel, MJ, Al-Jarrah, R, Armstrong, T, Cipriani, F, Fretland, ÅA, Suhool, A, Bemelmans, M, Bosscha, K, Braat, AE, De Boer, MT, Dejong, CHC, Doornebosch, PG, Draaisma, WA, Gerhards, MF, Gobardhan, PD, Hagendoorn, J, Kazemier, G, Klaase, J, Leclercq, WKG, Liem, MS, Lips, DJ, Marsman, HA, Mieog, JSD, Molenaar, QI, Nieuwenhuijs, VB, Nota, CL, Patijn, GA, Rijken, AM, Slooter, GD, Stommel, MWJ, Swijnenburg, RJ, Tanis, PJ, Te Riele, WW, Terkivatan, T, Van den Tol, PMP, Van den Boezem, PB, Van der Hoeven, JA, Vermaas, M, Edwin, B, Aldrighetti, LA, Van Dam, RM, Abu Hilal, M & Besselink, MG 2021, 'Comparing practice and outcome of laparoscopic liver resection between high-volume expert centres and nationwide low-to-medium volume centres', The British journal of surgery, vol. 108, no. 8, pp. 983-990. https://doi.org/10.1093/bjs/znab096

TY - JOUR

T1 - Comparing practice and outcome of laparoscopic liver resection between high-volume expert centres and nationwide low-to-medium volume centres

AU - Görgec, B.

AU - Fichtinger, R. S.

AU - Ratti, F.

AU - Aghayan, D.

AU - Van der Poel, M. J.

AU - Al-Jarrah, R.

AU - Armstrong, T.

AU - Cipriani, F.

AU - Fretland, ÅA

AU - Suhool, A.

AU - Bemelmans, M.

AU - Bosscha, K.

AU - Braat, A. E.

AU - De Boer, M. T.

AU - Dejong, C. H.C.

AU - Doornebosch, P. G.

AU - Draaisma, W. A.

AU - Gerhards, M. F.

AU - Gobardhan, P. D.

AU - Hagendoorn, J.

AU - Kazemier, G.

AU - Klaase, J.

AU - Leclercq, W. K.G.

AU - Liem, M. S.

AU - Lips, D. J.

AU - Marsman, H. A.

AU - Mieog, J. S.D.

AU - Molenaar, Q. I.

AU - Nieuwenhuijs, V. B.

AU - Nota, C. L.

AU - Patijn, G. A.

AU - Rijken, A. M.

AU - Slooter, G. D.

AU - Stommel, M. W.J.

AU - Swijnenburg, R. J.

AU - Tanis, P. J.

AU - Te Riele, W. W.

AU - Terkivatan, T.

AU - Van den Tol, P. M.P.

AU - Van den Boezem, P. B.

AU - Van der Hoeven, J. A.

AU - Vermaas, M.

AU - Edwin, B.

AU - Aldrighetti, L. A.

AU - Van Dam, R. M.

AU - Abu Hilal, M.

AU - Besselink, M. G.

PY - 2021/8/19

Y1 - 2021/8/19

N2 - 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.

AB - 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.

KW - Aged

KW - Carcinoma, Hepatocellular/surgery

KW - Female

KW - Follow-Up Studies

KW - Hepatectomy/methods

KW - Hospitals, High-Volume/statistics & numerical data

KW - Humans

KW - Incidence

KW - Laparoscopy/methods

KW - Liver Neoplasms/surgery

KW - Male

KW - Middle Aged

KW - Netherlands/epidemiology

KW - Postoperative Complications/epidemiology

KW - Propensity Score

KW - Retrospective Studies

KW - Risk Factors

UR - http://www.scopus.com/inward/record.url?scp=85116172365&partnerID=8YFLogxK

U2 - 10.1093/bjs/znab096

DO - 10.1093/bjs/znab096

M3 - Article

C2 - 34195799

AN - SCOPUS:85116172365

SN - 1365-2168

VL - 108

SP - 983

EP - 990

JO - The British journal of surgery

JF - The British journal of surgery

IS - 8

ER -

Comparing practice and outcome of laparoscopic liver resection between high-volume expert centres and nationwide low-to-medium volume centres

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