Abstracts
1998 Digestive Disease Week

#1036

DO HEPATIC RESECTIONS NEED TO BE PERFORMED AT HIGH-VOLUME REFERRAL CENTERS? William P. Reed, M.D.,Beth A. Halla, R.N., Jane L. Garb, Baystate Medical Center, Springfield, MA.

Data presented at the 1997 Annual Meeting of the Society for Surgery of the Alimentary Tract (Gastroenterol 1997; 112:A1435) purports to show a relationship between the mortality rates from liver resection of primary or metastatic tumors and the volume of procedures performed per year at institutions in Maryland, low-volume centers (<15 cases per year) demonstrating 4.7 times the mortality of high-volume centers. The report lists only one high-volume center in Maryland. That center performed in excess of 40 cases each year with an operative mortality rate of 2%. Other Maryland centers performed no more than 11 cases per year with a mortality rate of 9.3%. To see if this report raised realistic concerns, we analyzed the results at our own institution, which began to offer hepatic tumor resection in 1986 when a surgical oncologist, trained in resection techniques, joined the faculty. In the ten years since then, 67 hepatic resections have been performed in 64 patients for a low-volume center rate of 6.7 per year. Ten procedures were performed for primary hepatic tumors, the remainder for metastatic disease. The overall mortality rate was 1.5% (0% for primary, 1.8% for metastatic) which compares favorably with the overall mortality from the high-volume Maryland group of 2.0% (6.5% for primary, 0% for metastatic). Selection criteria for our series were broad, including patients with up to seven metastatic lesions. Despite this, the five-year survival was 30%, comparable to the national average of 33%. No five-year survival data was provided in the Maryland Study for comparison. Our results contradict these conclusions from Maryland and demonstrate that with adequate training and skill, surgeons can safely perform hepatic resection to treat primary or metastatic liver tumors even at low-volume case loads of less than one resection per month.

Copyright 1996 - 1998, SSAT, Inc. Revised 29 June 1998.