18 Citations (Scopus)


Background and Aim: No study has examined associations between physician volume or hospital volume and survival in patients with liver malignancies in the hepatitis B virus-endemic areas such as Taiwan. This study was to examine the effect of hospital and surgeon volume on 5-year survival and to determine whether hospital or surgeon volume is the stronger predictor in patients with hepatocellular carcinoma after hepatic resection in Taiwan. Methods: Using the 1997-1999 Taiwan National Health Insurance Research Database and the 1997-2004 Cause of Death Data File, we identified 2,799 patients who underwent hepatic resection and 1,836 deaths during the 5-year follow-up period. The Cox proportional hazard regressions were performed to adjust for patient demographics, comorbidity, physician, and hospital characteristics when assessing the association of hospital and surgeon volume with 5-year survival. Results: When we examined the effect of physician and hospital volumes separately, both physician and hospital volumes significantly predicted 5-year survival after adjusting for characteristics of patient, surgeon, and hospital. However, after we adjusted for characteristics of physician and hospital, only physician volume remained a significant predictor of the 5-year survival. Conclusions: Physician volume is a stronger predictor of 5-year survival in hepatocellular carcinoma patients receiving hepatic resection.

Original languageEnglish
Pages (from-to)2284-2291
Number of pages8
JournalJournal of Gastrointestinal Surgery
Issue number12
Publication statusPublished - Dec 2009


  • Hepatocellular carcinoma
  • Hospital volume
  • Physician volume
  • Survival
  • Taiwan

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology


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