Abstract
Background: Pediatric liver surgery is complex, and complications are not uncommon. Centralization of highly specialized surgery has been shown to improve quality of care. In 2012, pediatric liver surgery was centralized in Switzerland in one national center. This study analyses results before and after centralization. Methods: Retrospective monocentric comparative study. Analysis of medical records of children (0–16 years) operated for any liver tumor between 1 January 2001 and 31 December 2020. Forty-one patients were included: 14 before centralization (before 1 January 2012) and 27 after centralization (after 1 January 2012). Epidemiological, pre-, intra-, and post-operative data were collected. Fischer’s exact and t-test were used to compare groups. Results: The two cohorts were homogeneous. Operating time was reduced, although not significantly, from 366 to 277 min. Length of postoperative stay and mortality were not statistically different between groups. Yet, after centralization, overall postoperative complication rate decreased significantly from 57% to 15% (p = 0.01), Clavien > III complications decreased from 50% to 7% (p < 0.01), and hepatic recurrences were also significantly reduced (40% to 5%, p = 0.03). Conclusion: Centralization of the surgical management of liver tumors in Switzerland has improved quality of care in our center by significantly reducing postoperative complications and hepatic recurrence.
Highlights
Liver tumors are associated with prematurity, chronic hepatitis, Beckwith–Wiedemann syndrome, neurofibromatosis, trisomy 21, and other conditions that may favor their occurrence [2]
There were no differences between groups in regards to gender distribution, age at diagnosis, prematurity, birth weight, associated conditions or syndromes, tumor characteristics, and weight at surgery
This study, in the setting of children needing liver surgery, scientifically confirms the intuitive impression that an increased case load after centralization reduces the rate of postoperative complications and increases the quality of care
Summary
Liver tumors are rare in children, accounting for 1% of all pediatric tumors. Two-thirds of cases are malignant, with hepatoblastoma (37%), hepatocellular carcinoma (21%), and undifferentiated embryonal sarcoma of the liver (8%) being the most frequent ones; one-third are benign tumors, such as hemangioma, focal nodular hyperplasia, and mesenchymal hamartoma [1]. Liver tumors are associated with prematurity, chronic hepatitis, Beckwith–Wiedemann syndrome, neurofibromatosis, trisomy 21, and other conditions that may favor their occurrence [2]. Children 2022, 9, 217 prematurity, chronic hepatitis, Beckwith–Wiedemann syndrome, neurofibromatosis, of tri somy 21, and other conditions that may favor their occurrence [2]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
