• Chih-Cheng Lu, Chong-Chi Chiu, Jhi-Joung Wang, Yu-Hsien Chiu, and Hon-Yi Shi.
• Department of Surgery, Chi Mei Medical Center, Liouying, Taiwan.
• J. Gastrointest. Surg. 2014 Jun 1;18(6):1138-45.

ObjectiveThe objective of this study was to explore volume-outcome associations after major hepatectomy for hepatocellular carcinoma (HCC).MethodsThis population-based cohort study retrospectively analyzed 23,107 major hepatectomies for HCC patients from 1998 to 2009. Relationships between hospital/surgeon volume and patient outcome were analyzed by propensity score matching (PSM). Five-year overall survival (OS) was estimated by Kaplan-Meier method, and differences were compared by log-rank test.ResultsThe mean length of stay (LOS) after major hepatectomy was 18.1 days, and the mean hospital cost was US$5,088.2. After PSM, the mean OS in high- and low-volume hospitals was 71.1 months (standard deviation (SD) 0.7 months) and 68.6 months (SD 0.6 months), respectively; the mean OS in high- and low-volume surgeons was 78.5 months (SD 0.7 months) and 66.9 months (SD 0.7 months), respectively. The PSM analysis showed that treatment by high-volume hospitals and treatment by high-volume surgeons were both associated with significantly shorter LOS, lower hospital cost, and longer survival compared to their low-volume counterparts (P < 0.001).ConclusionsThe results of this nationwide study support the regionalization of HCC treatment by hospital volume and by surgeon volume. High surgeon volume revealed both short- and long-term benefits. The applicability of PSM in volume-outcome analysis may also be confirmed.

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