Liver surgery in Italy. Criteria to identify the hospital units and the tertiary referral centers entitled to perform it.
During the last decades, liver surgery had an extraordinary evolution and diffusion thanks to a drastic reduction of operative mortality and morbidity rates. A debate is ongoing about the need for centralization of liver resections in tertiary referral centers. Robust evidences showed that complex surgical procedures have lower mortality rates when performed in high-volume centers. The present expert group reviewed the literature data and proposed guidelines to identify surgical units that should be entitled to perform liver surgery in Italy. Three separate types of requirements were identified. First, the hospital requirements that include the following criteria: (1) a hospital of 1st level according to the Italian law; (2) the presence of a dedicated hepatobiliary or hepatobiliopancreatic unit or a team dedicated to liver surgery into a general surgery unit; (3) the mandatory presence of oncology, hepatology, radiology, interventional radiology, digestive endoscopy, intensive care, and pathology units; (4) the availability of a liver transplant team into the hospital or into another hospital within an established partnership; (5) a periodic multidisciplinary meeting. Second, the volume requirements: the unit has to perform more than 20 liver resections per year for malignant liver diseases with a 90-day mortality rate < 3 %. Finally, the organization requirements: the presence of specific diagnostic-therapeutic flowcharts for liver diseases.
Division of Hepatobiliary and General Surgery, Department of Surgery, School of Medicine, Humanitas University, Humanitas Research Hospital, IRCCS, Via A. Manzoni, 56, Rozzano, 20089, Milan, Italy. guido.torzilli@hunimed.eu.
Guido
G
Torzilli
Division of Hepatobiliary and General Surgery, Department of Surgery, School of Medicine, Humanitas University, Humanitas Research Hospital, IRCCS, Via A. Manzoni, 56, Rozzano, 20089, Milan, Italy.
Luca
L
Viganò
Hepatobiliary Unit, Department of Surgery, Catholic University of the Sacred Heart, Rome, Italy.
Felice
F
Giuliante
Liver and Multiorgan Transplant Unit, S. Orsola Hospital, University of Bologna, Bologna, Italy.
Antonio Daniele
AD
Pinna
D000068:Accreditation; D006498:Hepatectomy / Q000379:methods*; D006757:Hospital Units; D006801:Humans; D007558:Italy; D008113:Liver Neoplasms / Q000601:surgery*; D062606:Tertiary Care Centers
Centralization; Hospital volume; Liver surgery; Minimal requirements; Mortality and morbidity; Multidisciplinary team