Contemporary practice and short-term outcomes after liver resections in a complete national cohort

Lassen, Kristoffer; Nymo, Linn Såve; Olsen, Frank; Brudvik, Kristoffer Watten; Søreide, Kjetil

doi:10.1007/s00423-018-1737-3

Cited by 15 publications

(14 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Available studies that reported on the volume–outcome relationship in liver surgery and showed lower mortality rates in high‐volume centres had low median hospital volumes of two to four procedures annually. The Dutch volume requirement of 20 liver resections annually is similar to that in several other countries. The mortality rates reported in series that used the 20‐procedure volume requirement (such as 2·0 per cent in the Netherlands and 2·1 per cent in Norway) are lower than those in countries that have not implemented such a cut‐off: 3·2 per cent in France, 4·9 per cent in America, 5·8 per cent in Germany and 3·1 per cent in Sweden.…”

Section: Discussionsupporting

confidence: 54%

“…The Dutch volume requirement of 20 liver resections annually is similar to that in several other countries. The mortality rates reported in series that used the 20‐procedure volume requirement (such as 2·0 per cent in the Netherlands and 2·1 per cent in Norway) are lower than those in countries that have not implemented such a cut‐off: 3·2 per cent in France, 4·9 per cent in America, 5·8 per cent in Germany and 3·1 per cent in Sweden. Such direct comparisons are biased by numerous factors including different inclusion criteria, definitions and cohort characteristics.…”

Section: Discussionmentioning

confidence: 77%

See 1 more Smart Citation

Volume–outcome relationship of liver surgery: a nationwide analysis

Olthof

Elfrink

Marra

et al. 2020

British Journal of Surgery

View full text Add to dashboard Cite

Background: Evidence for an association between hospital volume and outcomes for liver surgery is abundant. The current Dutch guideline requires a minimum volume of 20 annual procedures per centre. The aim of this study was to investigate the association between hospital volume and postoperative outcomes using data from the nationwide Dutch Hepato Biliary Audit.Methods: This was a nationwide study in the Netherlands. All liver resections reported in the Dutch Hepato Biliary Audit between 2014 and 2017 were included. Annual centre volume was calculated and classified in categories of 20 procedures per year. Main outcomes were major morbidity (Clavien-Dindo grade IIIA or higher) and 30-day or in-hospital mortality.Results: A total of 5590 liver resections were done across 34 centres with a median annual centre volume of 35 (i.q.r. 20-69) procedures. Overall major morbidity and mortality rates were 11⋅2 and 2⋅0 per cent respectively. The mortality rate was 1⋅9 per cent after resection for colorectal liver metastases (CRLMs), 1⋅2 per cent for non-CRLMs, 0⋅4 per cent for benign tumours, 4⋅9 per cent for hepatocellular carcinoma and 10⋅3 per cent for biliary tumours. Higher-volume centres performed more major liver resections, and more resections for hepatocellular carcinoma and biliary cancer. There was no association between hospital volume and either major morbidity or mortality in multivariable analysis, after adjustment for known risk factors for adverse events.

show abstract

Section: Discussionsupporting

confidence: 54%

Section: Discussionmentioning

confidence: 77%

Volume–outcome relationship of liver surgery: a nationwide analysis

Olthof

Elfrink

Marra

et al. 2020

British Journal of Surgery

View full text Add to dashboard Cite

show abstract

“…Hepatectomies are a heterogeneous group of procedures, ranging from laparoscopic wedge resection of a single segment to trisegmentectomy with bile duct resection and reconstruction 19 . Patients at highest risk of morbidity and mortality after hepatectomy are those with comorbidities, an age of 75 years or greater, or underlying cirrhosis; those undergoing major liver resection (≥4 liver segments), synchronous colorectal and liver resection, and biliary reconstruction; and those needing blood transfusions [19][20][21] . The risk of requiring care in an icu after surgery is higher for patients undergoing major hepatectomy and those receiving blood transfusions 22 .…”

Section: Therapeutic Options and Resource Usementioning

confidence: 99%

Strategies for the Delay of Surgery in the Management of Resectable Hepatobiliary Malignancies during the COVID-19 Pandemic

et al. 2020

View full text Add to dashboard Cite

Background Given the covid-19 pandemic, many jurisdictions, to spare resources, have limited access to operating rooms for elective surgical activity, including cancer, thus forcing deferral or cancellation of cancer surgeries. Surgery for hepatobiliary cancer is high-risk and particularly resource-intensive. Surgeons must critically appraise which patients will benefit most from surgery and which ones have other therapeutic options to delay surgery. Little guidance is currently available about potential delaying strategies for hepatobiliary cancers when surgery is not possible. Methods An international multidisciplinary panel reviewed the available literature to summarize data relating to standard-of-care surgical management and possible mitigating strategies to be used as a bridge to surgery for colorectal liver metastases, hepatocellular carcinoma, gallbladder cancer, intrahepatic cholangiocarcinoma, and hilar cholangiocarcinoma. Results Outcomes of surgery during the covid-19 pandemic are reviewed. Resource requirements are summarized, including logistics and adverse effects profiles for hepatectomy and delaying strategies using systemic, percutaneous and radiation ablative, and liver embolic therapies. For each cancer type, the long-term oncologic outcomes of hepatectomy and the clinical tools that can be used to prognosticate for individual patients are detailed. Conclusions There are a variety of delaying strategies to consider if availability of operating rooms decreases. This review summarizes available data to provide guidance about possible delaying strategies depending on patient, resource, institution, and systems factors. Multidisciplinary team discussions should be leveraged to consider patient- and tumour-specific information for each individual case.

show abstract

“…surgery after liver resection [10]. HCC patients are thought to be associated with impaired liver functional reserve.…”

Section: Plos Onementioning

confidence: 99%

Sex differences in disease presentation, surgical and oncological outcome of liver resection for primary and metastatic liver tumors—A retrospective multicenter study

et al. 2020

View full text Add to dashboard Cite

Background Sex differences are becoming of rising interest in many fields of medicine. It remains unknown whether sex has a role in postoperative and long-term outcome after hepatic resection (HR). The aim of this study was to investigate sex differences in disease presentation, surgical and oncological outcome after curative HR. Methods Retrospective analysis of 1010 patients who underwent HR between 2005 and 2018 at two tertiary hospitals in Austria. Demographics and survival data were obtained from a prospectively maintained database. Univariate analysis was used to identify sex differences for the entire cohort and for sub-cohorts. Disease-free- and overall survival was assessed by the Kaplan-Meier estimate and results were compared by log-rank tests. Results 436 females and 574 males were analyzed. Women were younger (p<0.001), had less liver cirrhosis (p<0.001), cardiac comorbidities (p<0.001), diabetes (28 (p<0.001) and obesity (p<0.001). Type of HR and surgical management did not vary by sex. Ninety-day morbidity (p = 0.179) and -mortality (p = 0.888) were comparable. In patients with malignant disease, no differences in disease-free- and overall survival was observed, neither for the entire cohort nor for the subgroups according to tumor entity or type of resection. Only in HCC patients, females showed an inferior OS (p = 0.029). Conclusion This study delivers new insights on the impact of sex differences in liver surgery. Despite the fact that male patients have a higher incidence of preoperative morbidities, we did not observe specific disparities in terms of immediate postoperative as well as long term oncological outcome between sexes.

show abstract

Contemporary practice and short-term outcomes after liver resections in a complete national cohort

Cited by 15 publications

References 34 publications

Volume–outcome relationship of liver surgery: a nationwide analysis

Volume–outcome relationship of liver surgery: a nationwide analysis

Strategies for the Delay of Surgery in the Management of Resectable Hepatobiliary Malignancies during the COVID-19 Pandemic

Sex differences in disease presentation, surgical and oncological outcome of liver resection for primary and metastatic liver tumors—A retrospective multicenter study

Contact Info

Product

Resources

About