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J Gastrointest Surg. 2014 Jun;18(6):1138-45. doi: 10.1007/s11605-014-2513-5. Epub 2014 Apr 15.

Volume-outcome associations after major hepatectomy for hepatocellular carcinoma: a nationwide Taiwan study.

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  • 1Department of Surgery, Chi Mei Medical Center, Liouying, Taiwan.

Abstract

OBJECTIVE:

The objective of this study was to explore volume-outcome associations after major hepatectomy for hepatocellular carcinoma (HCC).

METHODS:

This population-based cohort study retrospectively analyzed 23,107 major hepatectomies for HCC patients from 1998 to 2009. Relationships between hospital/surgeon volume and patient outcome were analyzed by propensity score matching (PSM). Five-year overall survival (OS) was estimated by Kaplan-Meier method, and differences were compared by log-rank test.

RESULTS:

The mean length of stay (LOS) after major hepatectomy was 18.1 days, and the mean hospital cost was US$5,088.2. After PSM, the mean OS in high- and low-volume hospitals was 71.1 months (standard deviation (SD) 0.7 months) and 68.6 months (SD 0.6 months), respectively; the mean OS in high- and low-volume surgeons was 78.5 months (SD 0.7 months) and 66.9 months (SD 0.7 months), respectively. The PSM analysis showed that treatment by high-volume hospitals and treatment by high-volume surgeons were both associated with significantly shorter LOS, lower hospital cost, and longer survival compared to their low-volume counterparts (P < 0.001).

CONCLUSIONS:

The results of this nationwide study support the regionalization of HCC treatment by hospital volume and by surgeon volume. High surgeon volume revealed both short- and long-term benefits. The applicability of PSM in volume-outcome analysis may also be confirmed.

PMID:
24733257
[PubMed - in process]
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