Hepatectomy for hepatocellular carcinoma in a community hospital: the importance of surgeon procedural volume in operative outcomes.
OBJECTIVE
Hospital procedural volume is shown to be important in affecting the postoperative mortality after major cancer surgery. Recent analysis demonstrates that hospital and surgeon volume effects on postoperative outcomes after major operations are actually interdependent and surgeon volume may be more important. The effects of hospital and surgeon volume on postoperative outcomes after hepatectomy for hepatocellular carcinoma are uncertain.


METHODS
A retrospective study was conducted of 65 patients who had undergone hepatectomy for hepatocellular carcinoma in a 6-year period. A specialized hepatobiliary team was set up in 2002 in the Kwong Wah Hospital. The postoperative outcomes of patients operated between 1999 and 2001 (Group 1) were compared to that of those treated between 2002 and 2004 (Group 2).


RESULTS
The hospital mortality was 8.3% in Group 1 and 3.4% in Group 2 (p = 0.393). The postoperative morbidity was 50% in Group 1 but decreased to 27.6% in Group 2, though the difference was not statistically significant (p = 0.056). The median hospital stay of patients in Group 2 was significantly shorter than that of those in Group 1 (17 days vs. 11 days, p = 0.005).


CONCLUSIONS
Despite the unchanged hospital volume, concentration of patients into a single team increases surgeon volume and improves postoperative outcomes after hepatectomy for hepatocellular carcinoma.
Yeung
Yuk Pang
YP
Division of Hepatobilliary Surgery, Department of Surgery, Kwong Wah Hospital, Hong Kong, China. yeungyp@yahoo.com
Hui
Joseph
J
Yip
Wai Chun Andrew
WC
D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D005260:Female; D013502:General Surgery / Q000706:statistics & numerical data; D006498:Hepatectomy / Q000706:statistics & numerical data*; D006764:Hospitals, Community; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome