Comparing practice and outcome of laparoscopic liver resection between high-volume expert centres and nationwide low-to-medium volume centres
Authors: Görgec B , Fichtinger R S , Ratti F , Aghayan D , Van der Poel M J , Al-Jarrah R , Armstrong T , Cipriani F , Fretland Å A , Suhool A , Bemelmans M , Bosscha K , Braat A E , De Boer M T , Dejong C H C , Doornebosch P G , Draaisma W A , Gerhards M F , Gobardhan P D , Hagendoorn J , Kazemier G , Klaase J , Leclercq W K G , Liem M S , Lips D J , Marsman H A , Mieog J S D , Molenaar Q I , Nieuwenhuijs V B , Nota C L , Patijn G A , Rijken A M , Slooter G D , Stommel M W J , Swijnenburg R J , Tanis P J , Te Riele W W , Terkivatan T , Van den Tol P M P , Van den Boezem P B , Van der Hoeven J A , Vermaas M , Edwin B , Aldrighetti L A , Van Dam R M , Abu Hilal M , Besselink M G 
Published: February 2021

Abstract

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 &gt;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 &lt; 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 &lt; 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 &lt; 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.