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

B. Gorgec, R.S. Fichtinger, F. Ratti, D. Aghayan, M.J. Van der Poel, R. Al-Jarrah, T. Armstrong, F. Cipriani, A.A. 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*, Dutch Liver Collaborative Group

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


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 languageEnglish
Pages (from-to)983-990
Number of pages8
JournalBritish Journal of Surgery
Issue number8
Publication statusPublished - 1 Aug 2021


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