Abstract
Background
Recent reviews of state and national databases suggest that hospital volume is inversely
proportional to morbidity after hepatic and pancreatic resection. Volume may be a
surrogate marker for factors such as coordination of care and surgeon training. The
authors hypothesized that low-volume centers can obtain acceptable outcomes if these
requirements are satisfied.
Methods
A retrospective review was performed of all hepatic and pancreatic resections performed
from 1978 to 2008 by 1 surgeon at 1 low-volume institution. The etiology of disease,
type of resection, and 30-day morbidity and mortality were assessed.
Results
One hundred sixty-eight hepatic resections were performed for malignant (76%) or benign
(24%) etiologies. Major resections included extended lobectomy (n = 19), lobectomy
(n = 58), and segmentectomy (n = 62); minor resections consisted of wedge resections
(n = 29). Overall 30-day mortality was 1.8%, and major morbidity was 17.9%; for major
hepatic resections, mortality and morbidity were 1.4% and 20.1%, respectively. One
hundred fourteen pancreatic resections were performed for malignant (76.3%) or benign
(23.7%) etiologies. Major resections included pancreaticoduodenectomy (n = 91), central
pancreatectomy (n = 1), and total pancreatectomy (n = 4); minor resections consisted
of distal pancreatectomy (n = 18). Overall 30-day mortality was 2.6%, and major morbidity
was 27.2%; for major pancreatic resections, mortality and morbidity were 3.1% and
31.3%, respectively.
Conclusions
Hepatic and pancreatic resections can be performed safely at a low-volume hospital
with adequate surgeon training and perioperative systems of care.
Keywords
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Article info
Publication history
Received in revised form:
October 7,
2010
Received:
July 15,
2010
Identification
Copyright
© 2011 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
