Prospective Study
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World J Gastroenterol. Dec 28, 2014; 20(48): 18445-18451
Published online Dec 28, 2014. doi: 10.3748/wjg.v20.i48.18445
Influence of high- and low-volume liver surgery in gallbladder carcinoma
Thorsten Oliver Goetze, Vittorio Paolucci
Thorsten Oliver Goetze, Vittorio Paolucci, Department of Surgery, Ketteler-Krankenhaus, 63071 Offenbach, Germany
Author contributions: Goetze TO and Paolucci V analyzed the data wrote and revised the manuscript; all authors read and approved the final manuscript.
Correspondence to: Thorsten Oliver Goetze, MD, Department of Surgery, Ketteler-Krankenhaus, Lichteplattenweg 85, 63071 Offenbach, Germany. thgoetze@aol.com
Telephone: +49-1577-2527799 Fax: +49-6074-4846206
Received: April 7, 2014
Revised: June 17, 2014
Accepted: July 16, 2014
Published online: December 28, 2014
Processing time: 273 Days and 11.2 Hours
Abstract

AIM: To clarify whether the performance of liver resections (LR) for incidental gallbladder carcinoma (IGBC)’s depends more on the experience of the hospitals in liver surgery than on complying with the guidelines in Germany.

METHODS: For data analysis, we used the Surgical Association of Endoscopy and Ultrasound and Minimally Invasive Surgery Central Registry of “IGBC” of the German Society of Surgery (the German Registry). In 2010, we started a second form by requesting the frequency of LR at the various hospitals in Germany. The indication for LR was irrelevant. The aim was to determine the overall frequency of liver resections at the hospitals. We divided the hospitals according to their experience in liver surgery into high- (HV), mid- (MV), and low-volume (LV) LR hospitals.

RESULTS: This study includes 487 IGBC’s from 167 centers. There were 36 high-volume, 32 mid-volume, and 99 low-volume centers. In the high-volume centers, the mean (range) number of liver resections was 101 (40-300). In the mid-volume centers, the mean (range) number of liver resections was 26 (20-39). In the low-volume centers, the mean (range) number of liver resections was 6.5 (0-19) (P < 0.001). LV’s perform LR for T2-3 gallbladder carcinomas significantly less often than high-volume or mid-volume centers (χ2 = 13.78, P = 0.001). In HV’s and MV’s, 61% of the patients with an indication for liver resection underwent LR, but in LV centers, only 41% with an indication for LR underwent LR (P < 0.001). In cases of T1b carcinomas, LR was performed significantly more often in HV’s (P = 0.009).

CONCLUSION: The central problem is that the performance of the required liver resection in IGBC in Germany depends on the hospital experience in liver surgery and not on the recommendations of the German guidelines.

Keywords: Gallbladder carcinoma; Radical cholecystectomy; High-volume center; German-registry; Volume cut-off; Hepatobiliary surgery

Core tip: The indication for radical liver resection in incidental gallbladder carcinomas depends more on the experience of the hospitals in liver surgery than on the tumor stage of the primary carcinoma. In addition, the recommendations of high quality guidelines seemed to be ignored in radical surgery in incidental gallbladder carcinoma cases.