Combined HPB Volume Protects Hepatectomy Outcomes at Low-Volume Liver Centers
Susanna W.L. de Geus, Marianna V. Papageorge, Alison P. Woods, Sing Chau Ng, F. Thurston Drake, David McAneny, Teviah E. Sachs, Jennifer F. Tseng
Boston Medical Center, Boston, MA
Background: The purpose of this study was to assess how the overall volume of hepato-pancreato-biliary (HPB) cancer operations impacts outcomes of liver resection (LR) at low-volume liver surgery centers. Methods:The National Cancer Database (2004-2014) was queried for patients who underwent LR for liver or intrahepatic cancer. Hospital volume was determined separately for all HPB operations and LR. Centers were dichotomized as low- and high-volume centers based upon the national medians. Three study cohort were created: low-volume (LV) centers for both LR and HPB, mixed-volume (MV) centers with low-volume LR but high-volume HPB, and high-volume LR centers (HV). Results:Of 8,577 patients identified, 43.7%, 6.8%, and 49.5% patients were treated at LV, MV, and HV centers, respectively. LV hospitals were less likely to have a liver transplant center compared to MV and HV centers (p<0.001). On multivariable analysis, patients treated at LV centers had higher 30-day mortality compared to patients treated at HV centers (Odds Ratio [OR], 1.53; p<0.001). However, patients treated at MV facilities experienced comparable 30-day mortality to HV centers (OR, 0.90; p=0.658). Similar results were found for positive margin rates and overall survival. Conclusion:Hepatectomy outcomes at low-liver volume centers that nonetheless have substantial experience with HPB cancer operations have outcomes similar to those at high-volume LR centers. Our results demonstrate that the volume-outcome curve for HPB surgery may be assessed more holistically, and that patients may safely receive curative hepatectomy in their chosen centers if HPB volume criteria are met.
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