Clinical outcomes after major hepatectomy are acceptable in low-volume centers in the Caribbean

作     者：Shamir O Cawich Ravi Maharaj Vijay Naraynsingh Neil Pearce Wesley Francis Kimon O Bonadie Dexter A Thomas 

作者机构：Department of Clinical Surgical SciencesUniversity of the West Indies Department of SurgeryUniversity Hospital Southampton NHS Trust Department SurgeryUniversity of the West Indies Department SurgeryCayman Islands Health Service Authority 

出 版 物：《World Journal of Hepatology》 (世界肝病学杂志（英文版）（电子版）)

年 卷 期：2019年第11卷第2期

页      面：199-207页

学科分类：10[医学] 

主　　题：Liver Surgery Resection Caribbean Volume Outcomes 

摘      要：BACKGROUND Major hepatectomies are routinely performed because they are often the only curative treatment for metastatic liver *** has been a trend to concentrate major hepatectomies in referral hospitals that perform these operations at high *** high volume referral centers are usually located in developed countries,but many patients in developing nations are not able to access these centers because of financial limitations,lack of social support and/or travel ***,local hospitals are often the only options many of these patients have for surgical treatment of metastatic liver *** is the situation in many Caribbean *** To determine the clinical outcomes after major liver resections in a low-resource hepatobiliary center in the *** We prospectively studied all patients who underwent major liver resections over five *** following data were extracted:patient demographics,diagnoses,ECOG status,operation performed,post-operative morbidity and *** analyses were performed using SPSS ver 16.0 RESULTSThere were 69 major liver resections performed by two teams at a mean case volume of 13.8 major resections/***-nine major hepatic resections were performed for:colorectal liver metastases 40(58%),non-colorectal metastases 9(13%),hepatocellular carcinoma 8(11.6%),ruptured adenomas 4(5.8%),hilar cholangiocarcinomas 4(5.8%),hemangiomata 2(2.9%),trauma 1(1.5%) and hepatoblastoma 1(1.5%).Twenty-one patients had at least one complication,for an overall morbidity rate of 30.4%.There were minor complications in 17(24.6%)patients,major complications in 11(15.9%) patients and 4(5.8%) *** There are unique geographic,political and financial limitations to healthcare delivery in the ***,clinical outcomes are acceptable in the established,low-volume hepatobiliary centers in the Eastern Caribbean.