Implementation and outcome of minor and major minimally invasive liver surgery in the Netherlands.

Aged Attitude of Health Personnel Conversion to Open Surgery / statistics & numerical data Female Hepatectomy / statistics & numerical data Humans Laparoscopy / statistics & numerical data Learning Curve Liver / surgery Male Middle Aged Netherlands / epidemiology Operative Time Postoperative Complications / epidemiology Retrospective Studies Robotic Surgical Procedures / statistics & numerical data Surgeons Surveys and Questionnaires

Journal

HPB : the official journal of the International Hepato Pancreato Biliary Association

ISSN: 1477-2574

Titre abrégé: HPB (Oxford)

Pays: England

ID NLM: 100900921

Informations de publication

Date de publication:
12 2019

Historique:

received: 28 01 2019

revised: 25 04 2019

accepted: 07 05 2019

pubmed: 27 6 2019

medline: 15 7 2020

entrez: 26 6 2019

Statut: ppublish

Résumé

While most of the evidence on minimally invasive liver surgery (MILS) is derived from expert centers, nationwide outcomes remain underreported. This study aimed to evaluate the implementation and outcome of MILS on a nationwide scale. Electronic patient files were reviewed in all Dutch liver surgery centers and all patients undergoing MILS between 2011 and 2016 were selected. Operative outcomes were stratified based on extent of the resection and annual MILS volume. Overall, 6951 liver resections were included, with a median annual volume of 50 resections per center. The overall use of MILS was 13% (n = 916), which varied from 3% to 36% (P < 0.001) between centers. The nationwide use of MILS increased from 6% in 2011 to 23% in 2016 (P < 0.001). Outcomes of minor MILS were comparable with international studies (conversion 0-13%, mortality <1%). In centers which performed ≥20 MILS annually, major MILS was associated with less conversions (14 (11%) versus 41 (30%), P < 0.001), shorter operating time (184 (117-239) versus 200 (139-308) minutes, P = 0.010), and less overall complications (37 (30%) versus 58 (42%), P = 0.040). The nationwide use of MILS is increasing, although large variation remains between centers. Outcomes of major MILS are better in centers with higher volumes.

Sections du résumé

BACKGROUND

METHODS

Electronic patient files were reviewed in all Dutch liver surgery centers and all patients undergoing MILS between 2011 and 2016 were selected. Operative outcomes were stratified based on extent of the resection and annual MILS volume.

RESULTS

Overall, 6951 liver resections were included, with a median annual volume of 50 resections per center. The overall use of MILS was 13% (n = 916), which varied from 3% to 36% (P < 0.001) between centers. The nationwide use of MILS increased from 6% in 2011 to 23% in 2016 (P < 0.001). Outcomes of minor MILS were comparable with international studies (conversion 0-13%, mortality <1%). In centers which performed ≥20 MILS annually, major MILS was associated with less conversions (14 (11%) versus 41 (30%), P < 0.001), shorter operating time (184 (117-239) versus 200 (139-308) minutes, P = 0.010), and less overall complications (37 (30%) versus 58 (42%), P = 0.040).

CONCLUSION

The nationwide use of MILS is increasing, although large variation remains between centers. Outcomes of major MILS are better in centers with higher volumes.

Identifiants

DOI: 10.1016/j.hpb.2019.05.002 PMID: 31235430

pubmed: 31235430

pii: S1365-182X(19)30540-4

doi: 10.1016/j.hpb.2019.05.002

pii:

doi:

Types de publication

Journal Article Multicenter Study

Langues

eng

Sous-ensembles de citation

Pagination

1734-1743

Investigateurs

Babs Zonderhuis (B)

Inne B Rinkes (IB)

Christiaan Hoff (C)

Steven Oosterling (S)