150 Ablating the Future of HPB Training: Trends in Liver Resections and Ablation Procedures in England

Abstract Background Chemotherapy and intraoperative ultrasound-guided surgery has enabled surgeons to perform parenchymal sparing hepatectomies (PSH) and ablative therapies over major liver resections (MLR). However, the actual impact of PSH and ablative therapies on the number of MLRs is unknown. This study aims to examine trends in the types of liver resections and ablative therapies in England. Method A retrospective analysis of Hospital Episode Statistics (HES) data for all liver resections/ablations performed across England between April 2011 and March 2024. We compared the trends in MLR, PSH, and ablative therapies. Results 41,604 patients (males, 24,939; 60%, mean age, 62 years) underwent liver surgery or ablation. A total of 53,849 [(PSH=30,335 (56.3%), MLR=10,270 (19%), and ablations 13,244 (24.6%)] procedures were carried out. MLRs decreased from 1,063 in 2012 to 715 (33%, p=0.0006) in 2024, with a median annual decrease of 21% [(interquartile range (IQR): 4.52 to 32.8%, p=0.0008). PSH increased from 2,167 to 2,787 (29%, p = 0.003), with a median annual increase of 20% (IQR: 3.6 to 29.3%). The number of ablations has increased from 708 to 1,456 (a 106% increase, p = 0.02), with a median annual growth rate of 59.3% (IQR: 22.5%-105.65%). The median length of stay has decreased from 7 to 5.5 days (p = 0.03) and from 2 to 1 day (50%, p = 0.02) for PSH and ablations, respectively. Conclusions We observed a decreasing trend in major liver resections, which may have implications for future training in liver surgery and should be considered when designing future training curricula.