Comparing Practice and Outcome of Laparoscopic Liver Resection Between High-Volume Expert Centres and Nationwide Low-to-medium Volume Centres

Purpose: It is unknown how use and outcome of laparoscopic liver resection (LLR) compare between high-volume centres (HV) and low-medium volume centres (LMV). This study aimed to compare use and outcome of LLR according to surgical difficulty in three leading European HV and twenty Dutch LMV. Method: An international, retrospective multicentre cohort study including LLR data from three European HV and twenty Dutch LMV from January 2011 to December 2016. HV are defined by performing >50 LLR annually. Patients were retrospectively stratified into low-, moderate- and high-risk Southampton difficulty strata. Results: 2425 patients were included (1540 HV; 885 LMV). The annual volume of LLR was higher in HV than LMV (42.9% versus 7.2%). Patients in HV experienced fewer conversions (7.4 versus 13.1%; P<0.001) and less intraoperative incidents (9.3% versus 14.6%; P=0.002) compared to LMV. Whereas morbidity and mortality rates were similar, intervention rate (5.1% versus 7.2%; P=0.034) and postoperative hospital stay (3 versus 5 days; P<0.001) were lower in HV compared to LMV. Per difficulty score stratum, the conversion rate and postoperative hospital stay were lower in HV. The rate of intraoperative incidents was similar in the low-risk stratum, however lower in HV in the moderate-risk and high-risk strata (absolute difference 6.7% and 14.2%; P<0.004). Conclusion: HV had a sixfold higher use of LLR, less conversions, and shorter hospital stay, as compared to a nationwide LMV. Stratification into difficulty scores identified some differences but largely outcomes appeared better for HV in each risk group.