Volume–outcome relationship in anatomical and non-anatomical liver resections: a rapid systematic review

TL;DR

This review examines how hospital and surgeon volume affect outcomes in liver resections, finding that higher volume is linked to better results, but more research is needed.

Contribution

The study provides a rapid systematic review of the volume-outcome relationship in liver resections, highlighting gaps in surgeon volume and long-term outcomes.

Findings

Higher hospital and surgeon volume is associated with reduced mortality and fewer complications in liver resections.

The impact of volume on outcomes depends on the type of procedure and specific outcome parameters.

Evidence on surgeon volume and long-term outcomes remains limited and underexplored.

Abstract

Despite considerable advancements in recent decades, mortality and complications following liver resection remain high. The volume-outcome relationship has been the subject of extensive research and offers relevant potential for improvement of surgical outcomes. This review aims to examine the impact of hospital and surgeon volume on patient-relevant outcomes in liver resections and synthesize the available evidence.

A rapid systematic literature review was conducted, searching CENTRAL, Embase, PubMed, and study registries for articles published from 2000 to 2023. Eligible studies investigated the association between hospital or surgeon volume and patient-relevant outcomes in anatomical and non-anatomical liver resections. Study quality was assessed using the ISPOR and ROBINS-E checklists and reported alongside the results. The review protocol registered with PROSPERO (CRD42023398566).

The search yielded 3287 records, of which 38 publications met the inclusion criteria. All included studies were retrospective observational studies. A higher surgical volume was associated with improved patient-relevant outcomes, such as reduced mortality following both anatomical and non-anatomical liver resections and lower rates of postoperative complications. However, the results indicate that the impact of hospital or surgeon volume is limited and likely depends on the respective outcome parameter. A considerable gap remains with respect to long-term outcomes and quality of life, and studies investigating surgeon volume are scarce.

The findings provide evidence supporting a positive association between higher hospital volume and improved patient-relevant outcomes in liver resection. However, surgeon volume remains underexplored and the evidence from subgroups indicates that the impact of hospital or surgeon volume likely depends on study quality, procedure type, volume thresholds, and respective outcome parameters. Patient care could benefit from further research on long-term outcomes as well as quality of life, for which the current evidence is scarce.

The online version contains supplementary material available at 10.1186/s12876-025-04490-x.

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