Published online Feb 27, 2019. doi: 10.4254/wjh.v11.i2.199
Peer-review started: September 10, 2018
First decision: October 5, 2018
Revised: November 5, 2018
Accepted: January 28, 2019
Article in press: January 28, 2019
Published online: February 27, 2019
Major hepatectomies are routinely performed because they are often the only curative treatment for metastatic liver disease. There has been a trend to concentrate major hepatectomies in referral hospitals that perform these operations at high volumes. These 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 restrictions. Therefore, local hospitals are often the only options many of these patients have for surgical treatment of metastatic liver disease. This is the situation in many Caribbean countries.
To determine the clinical outcomes after major liver resections in a low-resource hepatobiliary center in the Caribbean.
We prospectively studied all patients who underwent major liver resections over five years. The following data were extracted: patient demographics, diagnoses, ECOG status, operation performed, post-operative morbidity and mortality. Statistical analyses were performed using SPSS ver 16.0
There were 69 major liver resections performed by two teams at a mean case volume of 13.8 major resections/year. Sixty-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%) deaths.
There are unique geographic, political and financial limitations to healthcare delivery in the Caribbean. Nevertheless, clinical outcomes are acceptable in the established, low-volume hepatobiliary centers in the Eastern Caribbean.
Core tip: Although there has been a global trend to concentrate major liver resections in tertiary referral centers, it is not practical in the Caribbean region. However, the hepatobiliary centers in the Caribbean do not meet the criteria to be defined as high-volume centers. This study prospectively evaluated outcomes after 69 consecutive major liver resections in a Caribbean center that only performed 13.8 resections per year. With a major morbidity rate of 15.9% and mortality rate of 5.8%, we have shown that the clinical outcomes after major liver resections are acceptable in the established, low-volume hepatobiliary centers in the Eastern Caribbean.