• B Görgec, R S Fichtinger, F Ratti, D Aghayan, M J Van der Poel, R Al-Jarrah, T Armstrong, F Cipriani, Å A Fretland, A Suhool, M Bemelmans, K Bosscha, A E Braat, M T De Boer, DejongC H CCHCDepartment of Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands and RWTH Aachen, Germany., P G Doornebosch, W A Draaisma, M F Gerhards, P D Gobardhan, J Hagendoorn, G Kazemier, J Klaase, W K G Leclercq, M S Liem, D J Lips, H A Marsman, J S D Mieog, Q I Molenaar, V B Nieuwenhuijs, C L Nota, G A Patijn, A M Rijken, G D Slooter, M W J Stommel, R J Swijnenburg, P J Tanis, W W Te Riele, T Terkivatan, P M P Van den Tol, P B Van den Boezem, J A Van der Hoeven, M Vermaas, B Edwin, L A Aldrighetti, R M Van Dam, M Abu Hilal, and M G Besselink.
• Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands.
• Br J Surg. 2021 Aug 19; 108 (8): 983-990.

BackgroundBased on excellent outcomes from high-volume centres, laparoscopic liver resection is increasingly being adopted into nationwide practice which typically includes low-medium volume centres. It is unknown how the use and outcome of laparoscopic liver resection compare between high-volume centres and low-medium volume centres. This study aimed to compare use and outcome of laparoscopic liver resection in three leading European high-volume centres and nationwide practice in the Netherlands.MethodAn international, retrospective multicentre cohort study including data from three European high-volume centres (Oslo, Southampton and Milan) and all 20 centres in the Netherlands performing laparoscopic liver resection (low-medium volume practice) from January 2011 to December 2016. A high-volume centre is defined as a centre performing >50 laparoscopic liver resections per year. Patients were retrospectively stratified into low, moderate- and high-risk Southampton difficulty score groups.ResultsA total of 2425 patients were included (1540 high-volume; 885 low-medium volume). The median annual proportion of laparoscopic liver resection was 42.9 per cent in high-volume centres and 7.2 per cent in low-medium volume centres. Patients in the high-volume centres had a lower conversion rate (7.4 versus 13.1 per cent; P < 0.001) with less intraoperative incidents (9.3 versus 14.6 per cent; P = 0.002) as compared to low-medium volume centres. Whereas postoperative morbidity and mortality rates were similar in the two groups, a lower reintervention rate (5.1 versus 7.2 per cent; P = 0.034) and a shorter postoperative hospital stay (3 versus 5 days; P < 0.001) were observed in the high-volume centres as compared to the low-medium volume centres. In each Southampton difficulty score group, the conversion rate was lower and hospital stay shorter in high-volume centres. The rate of intraoperative incidents did not differ in the low-risk group, whilst in the moderate-risk and high-risk groups this rate was lower in high-volume centres (absolute difference 6.7 and 14.2 per cent; all P < 0.004).ConclusionHigh-volume expert centres had a sixfold higher use of laparoscopic liver resection, less conversions, and shorter hospital stay, as compared to a nationwide low-medium volume practice. Stratification into Southampton difficulty score risk groups identified some differences but largely outcomes appeared better for high-volume centres in each risk group.© The Author(s) 2021. Published by Oxford University Press on behalf of BJS Society Ltd. All rights reserved. For permissions, please email: journals.permissions@oup.com.

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