title: Influence of high- and low-volume liver surgery in gallbladder carcinoma.
abstract: OBJECTIVE
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Thorsten Oliver Goetze, Vittorio Paolucci, Department of Surgery, Ketteler-Krankenhaus, 63071 Offenbach, Germany.
authors.forename: Thorsten Oliver
authors.initials: TO
authors.lastname: Goetze
authors.affiliation: Thorsten Oliver Goetze, Vittorio Paolucci, Department of Surgery, Ketteler-Krankenhaus, 63071 Offenbach, Germany.
authors.forename: Vittorio
authors.initials: V
authors.lastname: Paolucci
mesh_terms: D002277:Carcinoma / Q000601:surgery*; D005706:Gallbladder Neoplasms / Q000601:surgery*; D005858:Germany; D019983:Guideline Adherence / Q000639:trends; D006498:Hepatectomy / Q000592:standards / Q000639:trends*; D061847:Hospitals, High-Volume / Q000592:standards / Q000639:trends*; D061846:Hospitals, Low-Volume / Q000592:standards / Q000639:trends*; D006801:Humans; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000639:trends*; D012189:Retrospective Studies
keywords: Gallbladder carcinoma; German-registry; Hepatobiliary surgery; High-volume center; Radical cholecystectomy; Volume cut-off