The article from Glasgow et al for the first time describes the relationship between high volume and outcome after liver resection for HCC. The authors clearly demonstrate lower postoperative mortality rates and a shorter hospital stay for high-volume centers. These results are not surprising, as Gordon et al1 have already shown lower postoperative morbidity and mortality rates for other intricate oncological operations in visceral surgery: the early results after the Whipple operation were distinctly better in high-volume centers. Similar results have been published for orthopedic and traumatological operations, cardiac and vascular surgery, and gynecological operations. This proves that not only specific surgical technical skills but the combination of a well-equipped center with potent intensive care and experienced anesthesiologists as well as a general training for large operations are important for successful therapy. In conclusion, we merely learn a truism.
Herfarth C, Kienle P. Invited Critique: The Relationship Between Hospital Volume and Outcomes of Hepatic Resection for Hepatocellular Carcinoma. Arch Surg. 1999;134(1):35. doi:10.1001/archsurg.134.1.35