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Effect of Centralization on Surgical Outcome of Children Operated for Liver Tumors in Switzerland: A Retrospective
Jasmine Leoni1,2,3, Anne-Laure Rougemont1,4, Ana M Calinescu1,2,3
1Swiss Pediatric Liver Center, Geneva University Hospitals, 1205 Geneva, Switzerland.
Insights
Centralizing pediatric liver tumor surgery in Switzerland significantly reduced postoperative complications and hepatic recurrence. This improvement in care highlights the benefits of specialized surgical centers for children.
Area of Science:
- Pediatric Surgery
- Surgical Oncology
- Hepatobiliary Surgery
Background:
- Pediatric liver surgery presents significant challenges with frequent complications.
- Centralizing highly specialized surgical procedures can enhance patient care quality.
- Switzerland established a national center for pediatric liver surgery in 2012.
Purpose of the Study:
- To analyze the outcomes of pediatric liver tumor surgery before and after centralization.
- To evaluate the impact of a national center on surgical complication rates and recurrence.
- To assess changes in postoperative outcomes following the centralization of pediatric liver surgery.
Main Methods:
- Retrospective monocentric comparative study analyzing medical records.
- Inclusion of pediatric patients (0-16 years) operated for liver tumors between 2001 and 2020.
- Comparison of 14 patients before centralization (pre-2012) and 27 patients after centralization (post-2012).
Main Results:
- Overall postoperative complication rate significantly decreased from 57% to 15% (p=0.01).
- Severe complications (Clavien > III) reduced from 50% to 7% (p<0.01).
- Hepatic recurrence rates significantly dropped from 40% to 5% (p=0.03).
Conclusions:
- Centralization of pediatric liver tumor surgery in Switzerland improved care quality.
- The national center model led to significant reductions in postoperative complications.
- Centralization also resulted in a significant decrease in hepatic recurrence rates.
Background:
Pediatric liver surgery is complex, and complications are not uncommon. Centralization of highly specialized surgery has been shown to improve quality of care. In 2012, pediatric liver surgery was centralized in Switzerland in one national center. This study analyses results before and after centralization.
Methods:
Retrospective monocentric comparative study. Analysis of medical records of children (0-16 years) operated for any liver tumor between 1 January 2001 and 31 December 2020. Forty-one patients were included: 14 before centralization (before 1 January 2012) and 27 after centralization (after 1 January 2012). Epidemiological, pre-, intra-, and post-operative data were collected. Fischer's exact and t-test were used to compare groups.
Results:
The two cohorts were homogeneous. Operating time was reduced, although not significantly, from 366 to 277 min. Length of postoperative stay and mortality were not statistically different between groups. Yet, after centralization, overall postoperative complication rate decreased significantly from 57% to 15% (p = 0.01), Clavien > III complications decreased from 50% to 7% (p < 0.01), and hepatic recurrences were also significantly reduced (40% to 5%, p = 0.03).
Conclusion:
Centralization of the surgical management of liver tumors in Switzerland has improved quality of care in our center by significantly reducing postoperative complications and hepatic recurrence.
