Resource and manpower calculations for the provision of hepatobiliary surgical services in the UK

Abstract

G astrointestinal surgery in the UK is increasingly becoming sub-specialised into upper and lower gastrointestinal surgery with the management of patients being based on a multidisciplinary team approach. Upper gastrointestinal surgery is further divided into hepatopancreato-biliary surgery (HPB) and oesophago-gastric surgery.1 Most upper gastrointestinal surgeons treat patients with benign conditions affecting all these organs, but malignant conditions of the liver, bile duct and pancreas are increasingly dealt with by HPB surgeons 'super-specialising' in these organ systems. It is expected that a multidisciplinary approach to the management of upper GI cancer will allow better quality of care and decision-making and there is some evidence that Resource and manpower calculations for the provision of hepatobiliary surgical services in the UK

Body Mass Index and Adverse Perioperative Outcomes Following Hepatic Resection

“…The growing utilization of hepatobiliary surgical procedures in a more obese patient population demands that surgeons recognize the complex relationship between obesity and surgical outcomes 8–11. Several single center studies have demonstrated that obesity has specific implications on the health of the liver, but our understanding of how obesity affects multi-system complications is limited by descriptions with modest sample size 12–14.…”

Evaluation of the introduction of a standardised protocol for the staging and follow-up of colorectal cancer on resection rates for liver metastases

“…11 Hepatobiliary surgical expertise has become confined to these centres, which in turn are fed by a group of smaller regional hospitals, forming individual cancer 'networks'. This is the case in the North Trent Cancer Network, where Sheffield Teaching Hospitals NHS Trust provides liver and pancreatic surgical services to Sheffield itself and a group of four district hospitals (Fig.…”

Recent trends in liver resection surgery activity and population utilization rates in English regions

“…However, even if one assumes that all metastatic liver disease presentations among patients treated with liver resection surgery did relate to metastatic disease from colorectal primaries, this would have meant that the liver resection activity actually observed for colorectal liver metastases was about half the previously theoretically predicted population rate levels, i.e. 3.9/100 0000 8 .…”

“…It could therefore be postulated that diffusion of liver resection surgery might have been slow, and that provision of this type of surgery may have been below the healthcare need levels that could be theoretically expected. A previous study from an English liver surgery unit has indicated a theoretical healthcare need of approximately 3.9 liver resection surgery episodes for metastatic disease of the liver from colorectal primaries per 100 000 general population 8 . However, this evidence relates to only one study and research setting and to metastatic liver disease from colorectal primaries alone, i.e.…”