Dissemination of Minimally Invasive Liver Resection for Primary Malignancy: Reevaluating Effectiveness
- 105 Downloads
Experiences at specialized hepatobiliary centers have demonstrated efficacy of minimally invasive liver resection, but concerns exist regarding whether these procedures would remain effective once disseminated to a broad range of clinical practices. We sought to present the first comparison of MILR and open liver resection (OLR) for primary liver malignancy from a nationally representative cancer registry.
Cases of liver and intrahepatic bile duct cancer were identified from the National Cancer Data Base Participant Use File. Mixed effects logistic regression and stratified Cox proportional hazards regression were used for analysis. A propensity score matched cohort was used as an alternative form of analysis to evaluate the robustness of results.
A total of 3236 cases were analyzed from 2010 to 2011 with 2581 OLR (80%) and 655 MILR (20%). Of the variation in patient selection for MILR 28.5% was related to treatment at a specific treatment center; however, the proportion of MILR was similar among low-, medium-, and high-volume centers. Overall 90-day mortality was lower at high-volume centers (odds ratio [OR] 0.58; 95% confidence interval [CI] 0.40–0.85) compared with low-volume centers. MILR was similar to OLR in both 90-day mortality and overall survival (OR 0.9; 95% CI 0.62–1.10) and hazard ratio [HR] 0.88 (95% CI 0.72–1.07), regardless of treatment center volume.
MILR for primary liver malignancy is used across a variety of practice settings, with similar outcomes to OLR. While volume is associated with short-term outcomes of liver resection as a whole, this relationship is not explained by adoption of MILR at low-volume centers.
NIH T32 GM008516-21(PRV).
- 16.Fritz AGCN-R. I 2000. International Classification of Diseases for Oncology: ICD-O. 3rd ed. Geneva: World Health Organization; 2000.Google Scholar
- 17.Cancer C on. FORDS: Facility Oncology Registry Data Standards. American College of Surgeons; 2015.Google Scholar
- 20.Austin PC. Type I error rates, coverage of confidence intervals, and variance estimation in propensity-score matched analyses. Int J Biostat. 2009;5(1):Article 13. https://doi.org/10.2202/1557-4679.1146.
- 21.Cancer IA for R on. Statistical Methods in Cancer Research. Lyon: International Agency for Research on Cancer; 1980.Google Scholar
- 23.Morise Z, Ciria R, Cherqui D, Chen K-H, Belli G, Wakabayashi G. Can we expand the indications for laparoscopic liver resection? A systematic review and meta-analysis of laparoscopic liver resection for patients with hepatocellular carcinoma and chronic liver disease. J Hepatobiliary Pancreat Sci. 2015 https://doi.org/10.1002/jhbp.215.PubMedGoogle Scholar
- 29.Memeo R, de’Angelis N, Compagnon P, et al. Laparoscopic vs. open liver resection for hepatocellular carcinoma of cirrhotic liver: a case-control study. World J Surg. 2014;38(11):2919–26. https://doi.org/10.1007/s00268-014-2659-z.
- 31.Takahara T, Wakabayashi G, Beppu T, et al. Long-term and perioperative outcomes of laparoscopic versus open liver resection for hepatocellular carcinoma with propensity score matching: a multi-institutional Japanese study. J Hepatobiliary Pancreat Sci. 2015;22(10):721–7. https://doi.org/10.1002/jhbp.276.CrossRefPubMedGoogle Scholar
- 33.Birkmeyer JD, Sun Y, Wong SL, Stukel TA. Hospital volume and late survival after cancer surgery. Ann Surg. 2007;245(5):777–83. https://doi.org/10.1097/01.sla.0000252402.33814.dd.CrossRefPubMedPubMedCentralGoogle Scholar
- 34.Birkmeyer JD, Siewers AE, Finlayson EV a, et al. Hospital volume and surgical mortality in the United States. N Engl J Med. 2002;346(15):1128–37. https://doi.org/10.1056/nejmsa012337.