Goetze Thorsten Oliver, Paolucci Vittorio
Thorsten Oliver Goetze, Vittorio Paolucci, Department of Surgery, Ketteler-Krankenhaus, 63071 Offenbach, Germany.
World J Gastroenterol. 2014 Dec 28;20(48):18445-51. doi: 10.3748/wjg.v20.i48.18445.
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.
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.
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 (χ(2) = 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).
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.
明确德国偶然胆囊癌（IGBC）肝切除术（LR）的实施效果更多取决于肝脏手术医院的经验，还是遵循指南。
为进行数据分析，我们使用了德国外科学会的内镜与超声外科协会及微创外科中央注册中心的“IGBC”数据（德国注册中心）。2010年，我们通过询问德国各医院LR的频率开启了第二种形式。LR的指征无关紧要。目的是确定各医院肝切除术的总体频率。我们根据肝脏手术经验将医院分为高容量（HV）、中容量（MV）和低容量（LV）LR医院。
本研究纳入了来自167个中心的487例IGBC。有36个高容量中心、32个中容量中心和99个低容量中心。在高容量中心，肝切除术的平均（范围）数量为101（40 - 300）。在中容量中心，肝切除术的平均（范围）数量为26（20 - 39）。在低容量中心，肝切除术的平均（范围）数量为6.5（0 - 19）（P < 0.001）。LV对T2 - 3期胆囊癌进行LR的频率明显低于高容量或中容量中心（χ(2)=13.78，P = 0.001）。在HV和MV中，有肝切除指征的患者61%接受了LR，但在LV中心，有肝切除指征的患者只有41%接受了LR（P < 0.001）。在T1b期癌病例中，HV进行LR的频率明显更高（P = 0.009）。
核心问题是德国IGBC所需肝切除术的实施取决于肝脏手术医院的经验，而非德国指南的建议。
