Elective hepatic resection is feasible and safe in a regional centre

Gray, Andrew; Petrou, George; Rastogi, Pratik; Begbie, Stephen

doi:10.1111/ans.13828

Cited by 5 publications

(2 citation statements)

References 20 publications

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“…In Townsville, after introduction of a specialised hepatobiliary unit, there were no significant differences in operative approach or complexity, nor in mortality or complication rates between the two periods (ie, before and after the specialised hepatobiliary service) 22 . Similarly, a retrospective review of 66 consecutive liver resections following the introduction of the service rurally found comparable outcomes to published international series 60 …”

Section: Patient Outcomesmentioning

confidence: 75%

“…22 Similarly, a retrospective review of 66 consecutive liver resections following the introduction of the service rurally found comparable outcomes to published international series. 60 This is in contrast to breast cancer surgery, with evidence highlighting poorer outcomes when breast cancer surgery was performed rurally, including greater probabilities of re-operation, mastectomy, delay to chemotherapy and poorer five-year survival of patients compared with surgeries done in metropolitan areas. 61,62 These outcomes relate more to a lack of pathology services than surgical expertise, with an absence of intraoperative frozen section pathology.…”

Section: Patient Outcomesmentioning

confidence: 99%

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The provision of general surgery in rural Australia: a narrative review

Paynter,

Qin,

Brennan

et al. 2024

Medical Journal of Australia

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Summary Rural surgery is most commonly provided by general surgeons to the 29% of people (7 million) living in rural Australia. The provision of rural general surgery to enable equitable and safe surgical care for rural Australians is a multifaceted issue concerning recruitment, training, retention, surgical procedures and surgical outcomes. Sustaining the rural general surgical workforce will be dependent upon growing an increased number of resident rural general surgeons, as well as changed models of care, with a need for ongoing review to track the outcomes of these changes. To increase recruitment, rural general surgical training must improve to be less stressful for trainees and to be incorporated alongside a rural‐facing generalist curriculum. Rural general surgical outcomes (excluding some oncology conditions) achieve comparable results to metropolitan centres. Access to, and outcomes of, surgical oncology services continues to be inequitable for rural Australians and should be a major focus for improved service delivery.

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Section: Patient Outcomesmentioning

confidence: 75%

Section: Patient Outcomesmentioning

confidence: 99%

The provision of general surgery in rural Australia: a narrative review

Paynter,

Qin,

Brennan

et al. 2024

Medical Journal of Australia

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A Single Centre Experience with Pre-Operative Markers in the Prediction of Outcomes after Liver Resection for Hepatocellular Carcinoma

Peri

Lee

Fink

et al. 2023

Journal of Gastrointestinal Surgery

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Recent trends in postoperative mortality after liver resection- A systemic review and metanalysis of studies published in last 5 years and metaregression of various factors affecting 90 days mortality

Vasavada

Patel

2021

Preprint

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Aim: The aim of this systemic review and meta-analysis was to analyse 90 days mortality after liver resection, and also study various factors associated with mortality via univariate and multivariate metaregression. Methods: PubMed, Cochrane library, Embase, google scholar, web of science with keywords like liver resection, mortalit, hepatectomy. Weighted percentage 90 days mortalities were analysed. univariate metaregression was done by DerSimonian-Liard methods. Major hepatectomy, open surgery, cirrhotic livers, blood loss, hepatectomy for hepatocellular carcinoma, hepatectomy for colorectal liver metastasis were taken as moderators in metaregression analysis. We decided to enter all co-variants in multivariate model to look for mixed effects. Heterogeneity was assessed using the Higgins I2 test, with values of 25%, 50% and 75% indicating low, moderate and high degrees of heterogeneity. Cohort studies were assessed for bias using the Newcastle-Ottawa Scale to assess for the risk of bias. Publication bias was assessed using funnel plot. Funnel plot asymmetry was evaluated by Egger test. Results: Total 29931 patients data who underwent liver resections for various etiologies were pooled from 41 studied included1257 patients died within 90 days post operatively. Weighted 90 days mortality was 3.6% (95% C.I 2.8% -4.4%). However, heterogeneity of the analysis was high with I2 94.625%.(p<0.001). We analysed various covariates like major hepatectomy, Age of the patient, blood loss, open surgery, liver resections done for hepatocellular carcinoma or colorectal liver metastasis and cirrhotic liver to check for their association with heterogeneity in the analysis and hence 90 days mortality. On univariate metaregression analysis major hepatectomy (p<0.001), Open hepatectomy (p<0.001), blood loss (p=0.002) was associated with heterogeneity in the analysis and 90 days mortality. On multivariate metaregression Major hepatectomy(p=0.003) and Open surgery (p=0.012) was independently associated with higher 90 days mortality, and liver resection for colorectal liver metastasis was independently associated with lesser 90 days mortality (z= -4.11,p<0.01). Residual heterogeneity after all factor multivariate metaregression model was none (I2=0,Tau2=0, H2=1) and nonsignificant (p=0.49). Conclusion: Major hepatectomy, open hepatectomy, and cirrhotic background is associated with higher mortality rates and colorectal liver metastasis is associated with lower peri operative mortality rates.

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Elective hepatic resection is feasible and safe in a regional centre

Abstract: Our study shows excellent morbidity, mortality and survival for hepatic resectional surgery performed in a regional centre and is comparable data to major metropolitan centres. Our study confirms that major hepatic resectional surgery in this setting is safe and effective.

Cited by 5 publications

References 20 publications

The provision of general surgery in rural Australia: a narrative review

The provision of general surgery in rural Australia: a narrative review

A Single Centre Experience with Pre-Operative Markers in the Prediction of Outcomes after Liver Resection for Hepatocellular Carcinoma

Recent trends in postoperative mortality after liver resection- A systemic review and metanalysis of studies published in last 5 years and metaregression of various factors affecting 90 days mortality

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