LIVER RESECTION IN BRAZIL: A NATIONAL SURVEY

ABSTRACT Background: Liver surgery has developed significantly in the past decades. In Brazil, the interest on it has grown significantly, but there is no study regarding its clinical practice. Despite intrinsic limitations, surveys are well suited to descriptive studies and allow understanding the current scenario. Aim: To provide an overview on the current spread of liver surgery in Brazil, focusing on groups´ profile, operative techniques and availability of resources. Method: From May to November 2016, was conducted a national survey about liver surgery profile in Brazil composed by 28 questions concerning surgical team characteristics, technical preferences, surgical volume, results and available institutional resources. The survey was sent by e-mail to 84 liver surgery team leaders from different centers including all regions of the country. Results: Forty-three study participants (51.2%), from all Brazilian regions, responded the survey. Most centers have residency/fellowship programs (86%), perform and do laparoscopic procedures (91%); however, laparoscopy is still responsible for a little amount of surgeries (1-9% of laparoscopic procedures over all liver resections in 39.5% of groups). Only seven centers (16.3%) perform more than 50 liver resections/year. Postoperative mortality rate is between 1-3% in 55% of the centers. Conclusion: This is the first depiction of liver surgery in Brazil. It showed a surgical practice aligned with worldwide excellence centers, concentrated on hospitals dedicated to academic practice.

[1]  U. Neumann,et al.  Randomized clinical trial of open versus laparoscopic left lateral hepatic sectionectomy within an enhanced recovery after surgery programme (ORANGE II study) , 2017, The British journal of surgery.

[2]  T. Pawlik,et al.  Evaluating Trends in the Volume-Outcomes Relationship Following Liver Surgery: Does Regionalization Benefit All Patients the Same? , 2017, Journal of Gastrointestinal Surgery.

[3]  E. Santibañes,et al.  Training in hepato‐pancreato‐biliary surgery during residency: past, present and future perspectives , 2016, Journal of hepato-biliary-pancreatic sciences.

[4]  P. Herman,et al.  CENTRAL HEPATECTOMY FOR BILIARY CYSTADENOMA: PARENCHYMA-SPARING APPROACH FOR BENIGN LESIONS , 2016, Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery.

[5]  P. Herman,et al.  IS RESECTION OF HEPATOCELLULAR CARCINOMA IN THE ERA OF LIVER TRANSPLANTATION WORTHWILE? A single center experience. , 2016, Arquivos de gastroenterologia.

[6]  Yuhree Kim,et al.  Blood loss and outcomes after resection of colorectal liver metastases. , 2016, The Journal of surgical research.

[7]  G. Wakabayashi,et al.  Survey results on daily practice in open and laparoscopic liver resections from 27 centers participating in the second International Consensus Conference , 2016, Journal of hepato-biliary-pancreatic sciences.

[8]  G. Spolverato,et al.  The relative effect of hospital and surgeon volume on failure to rescue among patients undergoing liver resection for cancer. , 2016, Surgery.

[9]  O. Torres,et al.  THE LARGEST WESTERN EXPERIENCE WITH HEPATOPANCREATODUODENECTOMY: LESSONS LEARNED WITH 35 CASES , 2016, Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery.

[10]  I. Cecconello,et al.  Laparoscopic liver resection: Experience based guidelines. , 2016, World journal of gastrointestinal surgery.

[11]  José Roberto Alves,et al.  IMMEDIATE COMPLICATIONS AFTER 88 HEPATECTOMIES - BRAZILIAN CONSECUTIVE SERIES , 2016, Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery.

[12]  L. Casciola,et al.  Italian experience in minimally invasive liver surgery: a national survey , 2015, Updates in Surgery.

[13]  M. Machado,et al.  Anatomical basis for the intrahepatic glissonian approach during hepatectomies , 2015, Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery.

[14]  K. Hasegawa,et al.  A Worldwide Survey of the Current Daily Practice in Liver Surgery , 2013, Liver Cancer.

[15]  I. Cecconello,et al.  Hepatocellular adenoma: an excellent indication for laparoscopic liver resection. , 2012, HPB : the official journal of the International Hepato Pancreato Biliary Association.

[16]  Masakazu Yamamoto,et al.  Glissonean pedicle transection method for liver surgery (with video) , 2011, Journal of hepato-biliary-pancreatic sciences.

[17]  H. Bismuth,et al.  Milestones in the evolution of hepatic surgery. , 2011, Rambam Maimonides medical journal.

[18]  S. Breitenstein,et al.  “State of the Art” in Liver Resection and Living Donor Liver Transplantation: A Worldwide Survey of 100 Liver Centers—Reply to Letter , 2010, World Journal of Surgery.

[19]  P. Harris,et al.  Research electronic data capture (REDCap) - A metadata-driven methodology and workflow process for providing translational research informatics support , 2009, J. Biomed. Informatics.

[20]  M. Choti,et al.  The volume-outcomes effect in hepato-pancreato-biliary surgery: hospital versus surgeon contributions and specificity of the relationship. , 2009, Journal of the American College of Surgeons.

[21]  S. Breitenstein,et al.  “State of the Art” in Liver Resection and Living Donor Liver Transplantation: A Worldwide Survey of 100 Liver Centers , 2009, World Journal of Surgery.

[22]  M. Choti,et al.  Operative Mortality After Hepatic Resection: Are Literature-Based Rates Broadly Applicable? , 2007, Journal of Gastrointestinal Surgery.

[23]  K. Gurusamy,et al.  Routine abdominal drainage for uncomplicated liver resection. , 2007, The Cochrane database of systematic reviews.

[24]  R. Porte,et al.  Impact of Blood Loss on Outcome after Liver Resection , 2007, Digestive Surgery.

[25]  M. Lesurtel,et al.  How Should Transection of the Liver Be Performed?: A Prospective Randomized Study in 100 Consecutive Patients: Comparing Four Different Transection Strategies , 2005, Annals of surgery.

[26]  John A. Cowan,et al.  National trends in the use and outcomes of hepatic resection. , 2004, Journal of the American College of Surgeons.

[27]  J. Sitzia,et al.  Good practice in the conduct and reporting of survey research. , 2003, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[28]  J. Cameron,et al.  Statewide regionalization of pancreaticoduodenectomy and its effect on in-hospital mortality. , 1998, Annals of surgery.

[29]  J. Fischer,et al.  Liver resection. A comparison using the Nd-YAG laser, an ultrasonic surgical aspirator, or blunt dissection. , 1986, American Journal of Surgery.

[30]  T. Lin.  A Simplified Technique for Hepatic Resection: The Crush Method , 1974, Annals of surgery.

[31]  Pringle Jh,et al.  NOTES ON THE ARREST OF HEPATIC HEMORRHAGE DUE TO TRAUMA , 1908 .

[32]  A. Govindarajan,et al.  A survey of current practices and barriers to expanding laparoscopic HPB surgery in Canada. , 2017, HPB : the official journal of the International Hepato Pancreato Biliary Association.

[33]  J. Pringle.  V. Notes on the Arrest of Hepatic Hemorrhage Due to Trauma. , 1908, Annals of surgery.