Rakel Hekla Sigurðardóttir¹

Helgi Birgisson²

Jón Gunnlaugur Jónasson^1,3

Kristín Huld Haraldsdóttir^1,4

¹Faculty of Medicine, University of Iceland, ²Icelandic Cancer Registry, ³Department of Pathology, Landspitali University Hospital of Iceland, ⁴Department of Abdominal Surgery, Landspitali University Hospital of Iceland.

Correspondence: Kristín Huld Haraldsdóttir, kristinh@landspitali.is

Key words: liver surgery, liver cancer, intrahepatic cholangiocarcinoma, gallbladder cancer, liver metastasis.

INTRODUCTION: Cancers in the liver, bile duct system, gallbladder as well as metastases of the liver, have poor prognosis. Their treatment is comparable, with surgery being the most widespread, available curative treatment. Surgical treatment is anatomical or non-anatomical resection of the liver where the tumor and the adjacent liver tissue are removed.

MATERIALS/METHODS: A list of patients diagnosed with cancer in the liver, bile duct system, gallbladder or metastases of the liver, during the time period 2013-2017, was obtained from the Icelandic Cancer Registry. Additional information was retrieved from medical records and entered into the electronic quality registration forms of Landspítalinn. A comparison was made between Sweden and Iceland.

RESULTS: In total 108 patients were diagnosed with primary cancer of the liver, of which 24 (22%) underwent liver surgery. Of 264 diagnosed with liver metastases 38 (14%) underwent surgical treatment. A total of 63% of all reported cases were discussed at a multidisciplinary team meeting in Iceland but 93% in Sweden (p<0.0001). A sum of 29 patients (43%) developed complications within 30 days of surgery. Number of partial liver resections per 100.000 inhabitants were 2-8 in Iceland versus 4-13 in Sweden. The difference was even more apparent in patients with liver metastases.

CONCLUSION: Liver surgeries performed in Iceland seem to be comparable to Sweden in terms of complications and post operative mortality. In Iceland, considerably fewer operations are performed per capita, especially on liver metastases which could be explained by the fact that fewer patients are discussed at multidisciplinary team meetings.

 

Figure 1. Number of patients with primary cancer or metastasis in the liver in Iceland during the years 2013-2017.

*CRC: Colorectal cancer.

** Other liver cancers: Angiosarcoma n=1, unspecified sarcoma n=2, mixed HCC and iCCA n=2, non-specific liver cancer n=1.

Figure 2. Number of patients with cancer of the biliary tract or gallbladder in Iceland 2013-2017.

Figure 3. Number of partial liver resections per 100.000 for primary cancers of the liver, gallbladder or intrahepatic bile ducts, performed in various regions of Sweden and in Iceland. (SWE: Sweden)

Figure 4. Number of partial liver resections per 100.000 inhabitants per year for liver metastasis, performed in various regions of Sweden and in Iceland. (SWE: Sweden)

Figure 5. Proportion of operations based on the number of liver metastases in surgical patients in Iceland and Sweden.¹⁴

Figure 6. Proportion of patients who were discussed at a multidisciplinary team meeting by year in Iceland.

Table I. Median age and gender ratio in each disase group.

Table II. Types of surgical complications after liver surgery in Iceland compared with Sweden. Patient with more than one complication occurs more than once. The differences were statistically non significant.