Ressecção hepática em centro não académico em Portugal: que resultados?
Abstract
Objectivo: O crescimento do conhecimento médico produziu necessidades profundas de remodelação no funcionamento das Especialidades Médicas. Nesse contexto surgiram disciplinas dentro da Cirurgia Geral que, não sendo ainda subespecialidades, têm vindo a ser praticadas de forma cada vez mais independente, sobretudo nos hospitais de maiores dimensões. Em 2010 foi criado o grupo de estudo e tratamento de patologia Hepato-Bilio-Pancreática cirúrgica de um dos Serviços de Cirurgia Geral do Hospital dos Autores, que tem vindo a desenvolver actividade cirúrgica no âmbito da ressecção hepática. Decorridos cinco anos, os Autores pretendem avaliar os resultados da sua actividade e compará-los com os da literatura, nomeadamente com os resultados de centros de elevado volume. Material e Métodos: Foram analisados os registos efectuados em Base de Dados prospectiva que inclui todos os doentes submetidos a ressecção hepática electiva, no Serviço, entre Janeiro 2010 e Fevereiro de 2015. Resultados: A taxa de morbilidade global foi de 25,2%, metade da qual é relativa a complicações hepato-específicas. A taxa de complicações graves (Clavien-Dindo III e IV) foi de 11,7%. A mortalidade foi de 0,9%. Quatro vírgula nove porcento dos doentes necessitaram de re-intervenção. Conclusões: Os resultados obtidos são sobreponíveis aos publicados na literatura de centros de elevado volume. Mais do que o volume, a qualidade de cuidados é reflectida pela forma global como o doente é avaliado, tratado e seguido. Se utilizados os recursos e a metodologia apropriada, os doentes que necessitem de cirurgia de ressecção hepática podem ser operados com segurança fora de centros académicos.
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References
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43. Busch O, Hop W, van Papendrecht M, Marquet R, Jeekel J. Blood Transfusions and Prognosis in Colorectal Cancer. New England Journal of Medicine. 1993;328(19):1372-1376.
44. Kooby D, Stockman J, Ben-Porat L, Gonen M, Jarnagin W, Dematteo R et al. Influence of Transfusions on Perioperative and Long-Term Outcome in Patients Following Hepatic Resection for Colorectal Metastases. Annals of Surgery. 2003;237(6):860-870.
45. Wobbes T, Bemelmans B, Kuypers J, Beerthuizen G, Theeuwes A. Risk of postoperative septic complications after abdominal surgical treatment in relation to perioperative blood transfusion. Surgery, Gynecology and Obstetrics. 1990;171(1):59-62].
46. Nordlinger B, Guiguet M, Vaillant J, Balladur P, Boudjema K, Bachellier P et al. Surgical resection of colorectal carcinoma metastases tothe liver: A prognostic scoring system to improve case selection, based on 1568 patients. Cancer. 1996;77(7):1254-1262.
47. Rees M, Tekkis P, Welsh F, O’Rourke T, John T. Evaluation of Long-term Survival After Hepatic Resection for Metastatic Colorectal Cancer. Annals of Surgery. 2008;247(1):125-135.
48. Beppu T, Sakamoto Y, Hasegawa K, Honda G, Tanaka K, Kotera Y et al. A nomogram predicting disease-free survival in patients with colorectal liver metastases treated with hepatic resection: multicenter data collection as a Project Study for Hepatic Surgery of the Japanese Society of Hepato-Biliary-Pancreatic Surgery. Journal of Hepato-Biliary-Pancreatic Sciences. 2011;19(1):72-84.
49. Navarro F, Pessaux P, Sa Cunha A. Métastases hépatiques d’origine colorectale. Montrouge: Arnette; 2014.
50. Adam R, Hoti E, Bredt LC. Oncosurgical strategies for metastatic liver cancer. Cirugía Española. 2011;89(1):10-19.
51. Cocieru A, Saldinger P. HPB Surgery Can Be Safely Performed in a Community Teaching Hospital. J Gastrointest Surg. 2010;14(11):1853-1857.
2. Flexner A, Updike D. Medical education in the United States and Canada. 576 Fifth Avenue, New York City: [publisher not identified]; 1910.
3. Barroso E. The Pleasure of Surgery. Annals of Surgery. 2014;260(5):717-720.
4. Luft H, Bunker J, Enthoven A. Should Operations Be Regionalized?. New England Journal of Medicine. 1979;301(25):1364-1369.
5. Nygård I, Lassen K, Kjæve J, Revhaug A. Mortality and Survival Rates after Elective Hepatic Surgery in a Low-Volume Centre Are Comparable to Those of High-Volume Centres. ISRN Surgery. 2012;2012:1-5.
6. Figueras J, Fabregat J, Jaurrieta E, Valls C, Serrano T. Equipamiento, experiencia mínima y estándares en la cirugía hepatobiliopancreática (HBP). Cirugía Española. 2002;71(4):201-206.
7. Lehmann K, Clavien P. History of Hepatic Surgery. Surgical Clinics of North America. 2010;90(4):655-664.
8. Redai I, Emond J, Brentjens T. Anesthetic considerations during liver surgery. Surgical Clinics of North America. 2004;84(2):401-411.
9. Brown R, Bower M, Martin R. Hepatic Resection for Colorectal Liver Metastases. Surgical Clinics of North America. 2010;90(4):839-852.
10. Adam R, Lucidi V, Bismuth H. Hepatic colorectal metastases: methods of improving resectability. Surgical Clinics of North America. 2004;84(2):659-671.
11. Chen T, Wang H, Wang H, Song Y, Li X, Wang J. POSSUM and P-POSSUM as Predictors of Postoperative Morbidity and Mortality in Patients Undergoing Hepato-biliary pancreatic Surgery: A Meta-analysis. Annals of Surgical Oncology. 2013;20(8):2501-2510.
12. Dindo D, Demartines N, Clavien P. Classification of Surgical Complications. Annals of Surgery. 2004;240(2):205-213.
13. Guzzo M, Landercasper J, Boyd W, Lambert P. Outcomes of complex gastrointestinal procedures performed in a community hospital. Wisconsin Medical Journal. 2005;104(6):30-34.
14. Livermetsurvey.org. LiverMetSurvey Sanofi-Aventis [Internet]. 2015 [cited 12 April 2015]. Available from: http://www.livermetsurvey.org
15. Pringle J. Notes on the arrest of hepatic hemorrhage due to trauma. Annals of Surgery. 1908;48(4):541-549.
16. Goetze T. Influence of high- and low-volume liver surgery in gallbladder carcinoma. WJG. 2014;20(48):18445.
17. Choti M. Should hepatic resections be performed at high-volume referral centers?. Journal of Gastrointestinal Surgery. 1998;2(1):11-20.
18. Kingsnorth A. Major HPB Procedures Must be Undertaken in High Volume Quaternary Centres?. HPB Surgery. 2000;11(5):359-361.
19. Scarborough J, Pietrobon R, Bennett K, Clary B, Kuo P, Tyler D et al. Workforce Projections for Hepato-Pancreato-Biliary Surgery. Journal of the American College of Surgeons. 2008;206(4):678-684.
20. Dudley R, Johansen K, Brand R, Rennie D, Milstein A. Selective Referral to High-Volume Hospitals. JAMA. 2000;283(9):1159.
21. Dixon E, Vollmerjr C, Bathe O, Sutherland F. Training, practice, and referral patterns in hepatobiliary and pancreatic surgery: survey of general surgeons. Journal of Gastrointestinal Surgery. 2005;9(1):109-114.
22. Granger S, Glasgow R, Battaglia J, Lee R, Scaife C, Shrieve D et al. Development of a Dedicated Hepatopancreaticobiliary Program in a
University Hospital System. Journal of Gastrointestinal Surgery. 2005;9(7):891-895.
23. Schneider E, Ejaz A, Spolverato G, Hirose K, Makary M, Wolfgang C et al. Hospital Volume and Patient Outcomes in Hepato-Pancreatico- Biliary Surgery: Is Assessing Differences in Mortality Enough?. J Gastrointest Surg. 2014;18(12):2105-2115.
24. Ali N, O’Rourke C, El-Hayek K, Chalikonda S, Jeyarajah D, Walsh R. Estimating the need for hepato-pancreatico-biliary surgeons in the USA. HPB. 2014;17(4):352-356.
25. Nathan H, Cameron J, Choti M, Schulick R, Pawlik T. The Volume-Outcomes Effect in Hepato-Pancreato-Biliary Surgery: Hospital
Versus Surgeon Contributions and Specificity of the Relationship. Journal of the American College of Surgeons. 2009;208(4):528-538.
26. van Heek N, Kuhlmann K, Scholten R, de Castro S, Busch O, van Gulik T et al. Hospital Volume and Mortality After Pancreatic Resection. Annals of Surgery. 2005;242(6):781-790.
27. Swan R, Lau K, Sindram D, Iannitti D, Martinie J. Pancreatic Resection in a Large Tertiary Care Community-Based Hospital: Building a Successful Pancreatic Surgery Program. Surgical Oncology Clinics of North America. 2011;20(3):487-500.
28. Maddern G. Assuring quality in HPB surgery – efficacy and safety. MHPB. 2007;9(5):335-338.
29. Virani S, Michaelson J, Hutter M, Lancaster R, Warshaw A, Henderson W et al. Morbidity and Mortality after Liver Resection: Results of the Patient Safety in Surgery Study. Journal of the American College of Surgeons. 2007;204(6):1284-1292.
30. Barkun J, Lau J. Quality in hepatobiliary surgery. MHPB. 2007;9(5):329-329.
31. Langer B. Role of volume outcome data in assuring quality in HPB surgery. MHPB. 2007;9(5):330-334.
32. Lorenzo C, Limm W, Lurie F, Wong L. Factors affecting outcome in liver resection. HPB. 2005;7(3):226-230.
33. Csikesz N, Simons J, Tseng J, Shah S. Surgical Specialization and Operative Mortality in Hepato-Pancreatico-Biliary (HPB) Surgery. J Gastrointest Surg. 2008;12(9):1534-1539.
34. Scudamore C. Liver transplantation and resective surgery lessons learned: the case for a systems approach. The American Journal of Surgery. 2012;203(5):561-563.
35. Raval M, Bilimoria K, Talamonti M. Quality Improvement for Pancreatic Cancer Care: Is Regionalization a Feasible and Effective Mechanism?. Surgical Oncology Clinics of North America. 2010;19(2):371-390.
36. Birkmeyer J. Regionalization of High-Risk Surgery and Implications for Patient Travel Times. JAMA. 2003;290(20):2703.
37. Finlayson S, Birkmeyer J, Tosteson A, Nease R. Patient Preferences for Location of Care. Medical Care. 1999;37(2):204-209.
38. Dimick J, Finlayson S. Rural hospitals and volume standards in surgery. Surgery. 2006;140(3):367-371.
39. Lammert F, Neubrand M, Bittner R, Feussner H, Greiner L, Hagenmüller F et al. S3-Leitlinie der Deutschen Gesellschaft für Verdauungsund Stoffwechselkrankheiten und der Deutschen Gesellschaft für Viszeralchirurgie zur Diagnostik und Behandlung von Gallensteinen. Zeitschrift für Gastroenterologie. 2007;45(9):971-1001.
40. Portaldasaude.pt. Portal da Saúde – Início [Internet]. 2015 [cited 12 April 2015]. Available from: http://www.portaldasaude.pt/portal
41. Ine.pt. Portal do Instituto Nacional de Estatística [Internet]. 2015 [cited 12 April 2015]. Available from: http://www.ine.pt
42. Rosen C, Nagorney D, Taswell H, Helgeson S, Ilstrup D, van Heerden J et al. Perioperative Blood Transfusion and Determinants of Survival After Liver Resection for Metastatic Colorectal Carcinoma. Annals of Surgery. 1992;216(4):493-505.
43. Busch O, Hop W, van Papendrecht M, Marquet R, Jeekel J. Blood Transfusions and Prognosis in Colorectal Cancer. New England Journal of Medicine. 1993;328(19):1372-1376.
44. Kooby D, Stockman J, Ben-Porat L, Gonen M, Jarnagin W, Dematteo R et al. Influence of Transfusions on Perioperative and Long-Term Outcome in Patients Following Hepatic Resection for Colorectal Metastases. Annals of Surgery. 2003;237(6):860-870.
45. Wobbes T, Bemelmans B, Kuypers J, Beerthuizen G, Theeuwes A. Risk of postoperative septic complications after abdominal surgical treatment in relation to perioperative blood transfusion. Surgery, Gynecology and Obstetrics. 1990;171(1):59-62].
46. Nordlinger B, Guiguet M, Vaillant J, Balladur P, Boudjema K, Bachellier P et al. Surgical resection of colorectal carcinoma metastases tothe liver: A prognostic scoring system to improve case selection, based on 1568 patients. Cancer. 1996;77(7):1254-1262.
47. Rees M, Tekkis P, Welsh F, O’Rourke T, John T. Evaluation of Long-term Survival After Hepatic Resection for Metastatic Colorectal Cancer. Annals of Surgery. 2008;247(1):125-135.
48. Beppu T, Sakamoto Y, Hasegawa K, Honda G, Tanaka K, Kotera Y et al. A nomogram predicting disease-free survival in patients with colorectal liver metastases treated with hepatic resection: multicenter data collection as a Project Study for Hepatic Surgery of the Japanese Society of Hepato-Biliary-Pancreatic Surgery. Journal of Hepato-Biliary-Pancreatic Sciences. 2011;19(1):72-84.
49. Navarro F, Pessaux P, Sa Cunha A. Métastases hépatiques d’origine colorectale. Montrouge: Arnette; 2014.
50. Adam R, Hoti E, Bredt LC. Oncosurgical strategies for metastatic liver cancer. Cirugía Española. 2011;89(1):10-19.
51. Cocieru A, Saldinger P. HPB Surgery Can Be Safely Performed in a Community Teaching Hospital. J Gastrointest Surg. 2010;14(11):1853-1857.
Published
2016-09-30
How to Cite
PEREIRA, Jorge; CONSTANTINO, Júlio; PINHEIRO, Luis Filipe.
Ressecção hepática em centro não académico em Portugal: que resultados?.
Revista Portuguesa de Cirurgia, [S.l.], n. 38, p. 9 - 17, sep. 2016.
ISSN 2183-1165.
Available at: <https://revista.spcir.com/index.php/spcir/article/view/469>. Date accessed: 19 apr. 2024.
Section
Original Papers
