Abstract Background Neo-adjuvant chemotherapy and intraoperative ultrasound have widened eligibility for parenchymal-preserving liver surgery, while ablation offers comparable outcomes in selected patients. These shifts may reduce major liver resections, alter outcomes, and constrain training exposure. We quantified national trends to inform service planning and curricula. Methods Retrospective analysis of Hospital Episode Statistics for England, April 2012 to March 2024. Procedures were classified as major liver resection, right or left hemihepatectomy or extended hepatectomy, parenchymal-preserving liver surgery, non-anatomical resection, and ablation. Temporal trends and length of stay were assessed. Results Across 53 849 procedures, 30 335 were parenchymal-preserving resections, 56.3%, 10 270 major resections, 19.1%, and 13 244 ablations, 24.6%. In total, 41 604 patients were treated, 60% male, mean age 62 years. Major resections declined from 1063 in 2012 to 715 in 2024, a 33% reduction, P = 0.0006. Parenchymal-preserving resections increased from 2167 to 2787, a 29% rise, P = 0.003. Ablations more than doubled from 708 to 1456, a 106% increase, P = 0.02. Median length of stay fell for parenchymal-preserving surgery from 7 to 5.5 days, P = 0.03, and for ablation from 2 to 1 day, P = 0.02. Conclusions Over 2012 to 2024, national practice shifted towards organ-sparing resection and ablation with shorter stays, while volumes of major hepatectomy contracted. This rebalancing implies changes in case-mix and peri-operative efficiency, but reduced exposure to complex hepatectomy for trainees. Training and service configuration should adapt to preserve competence in major resections, consider concentrating high-complexity cases, and evaluate long-term oncological outcomes as adoption of parenchymal-preserving and ablative strategies expands.
Hassan et al. (Sun,) studied this question.