Influence of high- and low-volume liver surgery in gallbladder carcinoma.
World J Gastroenterol
; 20(48): 18445-51, 2014 Dec 28.
Article
em En
| MEDLINE
| ID: mdl-25561815
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 (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).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.Palavras-chave
Texto completo:
1
Bases de dados:
MEDLINE
Assunto principal:
Padrões de Prática Médica
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Carcinoma
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Hospitais com Alto Volume de Atendimentos
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Hospitais com Baixo Volume de Atendimentos
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Neoplasias da Vesícula Biliar
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Hepatectomia
Tipo de estudo:
Guideline
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Humans
País/Região como assunto:
Europa
Idioma:
En
Revista:
World J Gastroenterol
Assunto da revista:
GASTROENTEROLOGIA
Ano de publicação:
2014
Tipo de documento:
Article
País de afiliação:
Alemanha