Abstract
Introduction: Laparoscopic liver surgery has gradually been adopted in daily clinical practice(DCP). Although widely accepted that outcomes are better in high-volume expert(HVE) centers, it is unclear how outcomes compare in the various difficulty score strata. Methods: This was an international, retrospective multicenter study including data from 20 DCP liver surgery centers in the Netherlands and three HVE centers (January 2011-December 2016). Consecutive patients undergoing elective LLS for all indications were included. Patients were stratified into low-, moderate- and high-risk Southampton difficulty score groups. Results: A total of 2425 patients were included: 885 patients from DCP and 1540 patients from the HVE centers. In each risk group, the conversion rate was higher(6.7%; 5.7% and 11.4% absolute increase; all p< 0.001) and hospital stay was longer (2.0;3.3 and 2.2 days longer, all p< 0.001) in DCP centers compared to HVE centers. In the low-risk group, the rate of intraoperative incidents did not differ significantly, whereas it was significantly higher (24.5% vs 12.5%; p= 0.043) in the high-risk group in DCP compared to HVE centers. In none of the risk groups did severe postoperative complications and 90-day/in-hospital mortality differ between DCP and HVE centers. Conclusion: Outcomes of LLS for low-risk patients in DCP are similar to HVE centers, whereas high-risk procedures in DCP are more challenging and may have slightly inferior outcomes. Collaborating networks of liver centers could be established with each center focusing on a specific risk group and aiming for high volume LLS in the respective risk group.
Published Version
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