title: Hepatic resection at a major community-based teaching hospital can result in good outcome.
abstract: BACKGROUND
  The relationship between volume and outcome has been established in the literature for several complex surgical procedures. Improved outcome has been suggested at high-volume hospitals or with high-volume surgeons.
  
  
  METHODS
  The objective of this study was to evaluate the experience of a low-volume hospital with major liver resections. The setting of the study was a community-based teaching hospital with a surgical residency training program.
  
  
  RESULTS
  A total of 46 major liver resections were performed between January 1992 and December 2002. Procedures performed were hepatic lobectomies (n = 15; right, n = 11; left, n = 4), trisegmentectomies (n = 5; right, n = 3; left, n = 2), segmentectomies (n = 16; left lateral, n = 12; right posterior, n = 4), and wedge resections (n = 10). Operations were performed by 14 different surgeons; however, 23 operations were performed by 1 surgeon. Sixteen patients (34%) developed 23 complications. The average length of hospital stay was 9.7 days. There were no 30-day postoperative mortalities. Out of 46 patients who underwent major liver resection over the last 10 years, 13 patients are still alive. Overall survival ranged from 3 to 84 months, with a median survival of 30.6 months. The actual 5-year survival was 36% (8 of 22) for all patients operated on >5 years ago, and the actual 2-year survival was 61% (20 of 33).
  
  
  CONCLUSIONS
  Major liver resection can be performed safely with low rates of morbidity and operative mortality with careful selection of patients at a low-volume community-based teaching hospital.
authors.affiliation: Department of Surgery, Christiana Care Health Services, Helen F. Graham Cancer Center, 4701 Ogletown-Stanton Road, Newark, Delaware 19713, USA.
authors.forename: Ramaz E
authors.initials: RE
authors.lastname: Metreveli
authors.forename: Katherine
authors.initials: K
authors.lastname: Sahm
authors.forename: Frederick
authors.initials: F
authors.lastname: Denstman
authors.forename: Raafat
authors.initials: R
authors.lastname: Abdel-Misih
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Petrelli
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003691:Delaware / Q000453:epidemiology; D005260:Female; D013502:General Surgery / Q000706:statistics & numerical data; D006498:Hepatectomy / Q000379:methods / Q000706:statistics & numerical data*; D006764:Hospitals, Community / Q000706:statistics & numerical data*; D006784:Hospitals, Teaching / Q000706:statistics & numerical data*; D006801:Humans; D007396:Internship and Residency; D008113:Liver Neoplasms / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome