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Poel, M.J. van der; Fichtinger, R.S.; Bemelmans, M.; Bosscha, K.; Braat, A.E.; Boer, M.T. de; ... ; Dutch Liver Collaborative Grp (2019)

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

Article / Letter to editor
Background: 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.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...Show moreBackground: 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.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.Show less
All authors
Poel, M.J. van der; Fichtinger, R.S.; Bemelmans, M.; Bosscha, K.; Braat, A.E.; Boer, M.T. de; Dejong, C.H.C.; Doornebosch, P.G.; Draaisma, W.A.; Gerhards, M.F.; Gobardhan, P.D.; Gorgec, B.; 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.; Riele, W.W. te; Terkivatan, T.; Tol, P.M. van den; Boezem, P.B. van den; Hoeven, J.A. van der; Vermaas, M.; Abu Hilal, M.; Dam, R.M. van; Besselink, M.G.; Zonderhuis, B.; Rinkes, I.B.; Hoff, C.; Oosterling, S.; Dutch Liver Collaborative Grp
Date
2019-12-01
Journal
HPB
Volume
21
Issue
12
Pages
1734 - 1743
DOI
doi:10.1016/j.hpb.2019.05.002