Department of Hepatobiliary and General Surgery, Humanitas Clinical and Research Centre, Humanitas University, Rozzano, Italy.
Department of Surgery, Ospedale San Raffaele, Milan, Italy.
Br J Surg. 2020 Mar;107(4):443-451. doi: 10.1002/bjs.11369. Epub 2019 Dec 9.
Surgical outcomes may be associated with hospital volume and the influence of volume on minimally invasive liver surgery (MILS) is not known.
Patients entered into the prospective registry of the Italian Group of MILS from 2014 to 2018 were considered. Only centres with an accrual period of at least 12 months and stable MILS activity during the enrolment period were included. Case volume was defined by the mean number of minimally invasive liver resections performed per month (MILS/month).
A total of 2225 MILS operations were undertaken by 46 centres; nine centres performed more than two MILS/month (1376 patients) and 37 centres carried out two or fewer MILS/month (849 patients). The proportion of resections of anterolateral segments decreased with case volume, whereas that of major hepatectomies increased. Left lateral sectionectomies and resections of anterolateral segments had similar outcome in the two groups. Resections of posterosuperior segments and major hepatectomies had higher overall and severe morbidity rates in centres performing two or fewer MILS/month than in those undertaking a larger number (posterosuperior segments resections: overall morbidity 30·4 versus 18·7 per cent respectively, and severe morbidity 9·9 versus 4·0 per cent; left hepatectomy: 46 versus 22 per cent, and 19 versus 5 per cent; right hepatectomy: 42 versus 34 per cent, and 25 versus 15 per cent).
A volume-outcome association existed for minimally invasive hepatectomy. Complex and major resections may be best managed in high-volume centres.
手术结果可能与医院的手术量有关，但手术量对微创肝切除术（MILS）的影响尚不清楚。
纳入 2014 年至 2018 年期间参加意大利 MILS 研究组前瞻性注册的患者。仅纳入有至少 12 个月累积期且在入组期间 MILS 活动稳定的中心。病例量定义为每月进行微创肝切除术的平均例数（MILS/月）。
共进行了 2225 例 MILS 手术，由 46 个中心完成；9 个中心每月进行超过 2 例 MILS（1376 例患者），37 个中心每月进行 2 例或更少的 MILS（849 例患者）。随着病例量的增加，前外侧节段切除术的比例下降，而大肝切除术的比例增加。左外侧叶切除术和前外侧节段切除术在两组中的结果相似。在每月进行 2 例或更少 MILS 的中心，后上叶节段切除术和大肝切除术的总发病率和严重发病率均高于进行更多 MILS 的中心（后上叶节段切除术：总发病率分别为 30.4%和 18.7%，严重发病率分别为 9.9%和 4.0%；左半肝切除术：46%和 22%，19%和 5%；右半肝切除术：42%和 34%，25%和 15%）。
微创肝切除术存在量效关系。复杂和大的切除术可能最好在高容量中心进行管理。
