Effects of volume on outcome in hepatobiliary surgery: a review with guidelines proposal

Franchi, Eloisa; Donadon, Matteo; Torzilli, Guido

doi:10.35772/ghm.2020.01013

Cited by 11 publications

(9 citation statements)

References 55 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In line with previous studies, treatment at a high-volume hospital or by a high volume surgeon was signi cantly associated with good medical outcomes [15][16][17]. A previous study of a nationwide population provided additional insight into the combined effects of surgeon volume and hospital volume on survival after hepatic resection.…”

Section: Discussionsupporting

confidence: 78%

“…Another study reviewed proposed guidelines for hepatobiliary surgery and addressed the effects of volume on outcomes of hepatobiliary surgery. The authors recommended the establishment of an expert panel to draft preparatory and preliminary agreements on the clari cation and standardization of technical terminology used to discuss HCC resection and indicators for HCC resection [16]. Lu et al retrospectively analyzed 23,107 major hepatectomies for HCC patients and concluded that surgeon volume and hospital volume are signi cant independent predictors of postoperative recurrence (p<0.001) [17].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

5-year Recurrence Prediction After Hepatocellular Carcinoma Resection Using Deep Learning and Cox Regression Models: A Large Prospective Study

Shi

Lee²,

Chiu

et al. 2021

Preprint

View full text Add to dashboard Cite

BackgroundRisk of hepatocellular carcinoma (HCC) recurrence after surgical resection is unknown. Therefore, the aim of this study was 5-year recurrence prediction after HCC resection using deep learning and Cox regression models.MethodsThis study recruited 520 HCC patients who had undergone surgical resection at three medical centers in southern Taiwan between April, 2011, and December, 2015. Two popular deep learning algorithms: a deep neural network (DNN) model and a recurrent neural network (RNN) model and a Cox proportional hazard (CPH) regression model were designed to solve both classification problems and regression problems in predicting HCC recurrence. A feature importance analysis was also performed to identify confounding factors in the prediction of HCC recurrence in patients who had undergone resection.ResultsAll performance indices for the DNN model were significantly higher than those for the RNN model and the traditional CPH model (p<0.001). The most important confounding factor in 5-year recurrence after HCC resection was surgeon volume followed by, in order of importance, hospital volume, preoperative Beck Depression Scale score, preoperative Beck Anxiety Scale score, co-residence with family, tumor stage, and tumor size. ConclusionsThe DNN model is useful for early baseline prediction of 5-year recurrence after HCC resection. Its prediction accuracy can be improved by further training with temporal data collected from treated patients. The feature importance analysis performed in this study to investigate model interpretability provided important insights into the potential use of deep learning models for predicting recurrence after HCC resection and for identifying predictors of recurrence.

show abstract

Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 99%

5-year Recurrence Prediction After Hepatocellular Carcinoma Resection Using Deep Learning and Cox Regression Models: A Large Prospective Study

Shi

Lee²,

Chiu

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…There is evidence that high-volume surgeons have better outcomes than colleagues working in low-volume centers for colorectal [ 88 ], esophageal [ 89 ], and hepatobiliary [ 90 ] minimally invasive interventions. Also for emergency general surgery, data suggest an association between low-volume surgery and a higher risk of postoperative adverse events [ 91 ], particularly in frail populations [ 92 , 93 ].…”

Section: Resultsmentioning

confidence: 99%

Training curriculum in minimally invasive emergency digestive surgery: 2022 WSES position paper

et al. 2023

View full text Add to dashboard Cite

Background Minimally invasive surgery (MIS), including laparoscopic and robotic approaches, is widely adopted in elective digestive surgery, but selectively used for surgical emergencies. The present position paper summarizes the available evidence concerning the learning curve to achieve proficiency in emergency MIS and provides five expert opinion statements, which may form the basis for developing standardized curricula and training programs in emergency MIS. Methods This position paper was conducted according to the World Society of Emergency Surgery methodology. A steering committee and an international expert panel were involved in the critical appraisal of the literature and the development of the consensus statements. Results Thirteen studies regarding the learning curve in emergency MIS were selected. All but one study considered laparoscopic appendectomy. Only one study reported on emergency robotic surgery. In most of the studies, proficiency was achieved after an average of 30 procedures (range: 20–107) depending on the initial surgeon’s experience. High heterogeneity was noted in the way the learning curve was assessed. The experts claim that further studies investigating learning curve processes in emergency MIS are needed. The emergency surgeon curriculum should include a progressive and adequate training based on simulation, supervised clinical practice (proctoring), and surgical fellowships. The results should be evaluated by adopting a credentialing system to ensure quality standards. Surgical proficiency should be maintained with a minimum caseload and constantly evaluated. Moreover, the training process should involve the entire surgical team to facilitate the surgeon’s proficiency. Conclusions Limited evidence exists concerning the learning process in laparoscopic and robotic emergency surgery. The proposed statements should be seen as a preliminary guide for the surgical community while stressing the need for further research.

show abstract

“…We are aware that center volume correlates to results ( 55 – 58 ), but in a moment in which health migration constitutes a risk for the population due to the COVID19 pandemic ( 59 , 60 ), a Hub and Spoke Program for elective BS may offer patients the chance to be treated in the safest and most effective way without the costs and risks of health migration ( 20 ).…”

Section: Discussionmentioning

confidence: 99%

A Hub and Spoke Learning Program in Bariatric Surgery in a Small Region of Italy

Buondonno¹,

Avella

Cappuccio

et al. 2022

Front. Surg.

View full text Add to dashboard Cite

BackgroundMetabolic and bariatric surgery (BS) are considered life-changing and life-saving treatments for obese patients. The Italian Society of Obesity Surgery (SICOB) requires at least 25 operations per year to achieve the standard of care in the field. Despite the increasing need to treat obese patients, some small southern regions of Italy, such as Molise, do not have enough experience in bariatric procedures to be allowed to perform them. Therefore, our aim was to run a Hub and Spoke Program with a referral center in BS to treat obese patients and provide a proper learning curve in BS in Molise.MethodsIn 2020, the “A. Cardarelli Hospital” in Campobasso, Molise, started a formal “Learning Model of Hub and Spoke Collaboration” with the Hub center “Ospedale Del Mare”, Naples. A multidisciplinary approach was achieved. Patients were supervised and operated under the supervision and tutoring of the referral center. We retrospectively reviewed our prospectively collected database from February 2020 to August 2021 in order to analyze the safety and effectiveness of our learning program.ResultsIn total, 13 (3 men and 10 women) patients underwent BS with the mean age of 47.08 years and a presurgery BMI of 41.79. Seven (53.84%) patients were the American Society of Anesthesiologist (ASA) II, and 6 (46.16%) patients were ASA III. Twelve (92.31%) procedures were laparoscopic sleeve gastrectomies, 1 (7.69%) patient underwent endoscopic BioEnterics Intragastric Balloon (BIB) placement. One (8.33%) sleeve gastrectomy was associated to gastric band removal. Mean surgical time was 110.14 ± 23.54 min. The mean length of stay was 4.07 ± 2.40 days. No Clavien-Dindo ≥ III and mortality were reported. The follow-up program showed a mean decrease of 11.82 in terms of body mass index (BMI) value. The last 5 procedures were performed by the whole equips from “A. Cardarelli” under external tutoring without any impact on complication rate.ConclusionThe setup of a proper Hub and Spoke Program may allow to perform BS to provide the standard of care. This approach may reduce health costs and related patient migration.

show abstract

Effects of volume on outcome in hepatobiliary surgery: a review with guidelines proposal

Cited by 11 publications

References 55 publications

5-year Recurrence Prediction After Hepatocellular Carcinoma Resection Using Deep Learning and Cox Regression Models: A Large Prospective Study

5-year Recurrence Prediction After Hepatocellular Carcinoma Resection Using Deep Learning and Cox Regression Models: A Large Prospective Study

Training curriculum in minimally invasive emergency digestive surgery: 2022 WSES position paper

A Hub and Spoke Learning Program in Bariatric Surgery in a Small Region of Italy

Contact Info

Product

Resources

About