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Mortality and morbidity of hepatectomy, radiofrequency ablation, and embolization for hepatocellular carcinoma: a national survey of 54,145 patients

Authors
  • Sato, Masaya1
  • Tateishi, Ryosuke1
  • Yasunaga, Hideo2
  • Horiguchi, Hiromasa2
  • Yoshida, Haruhiko1
  • Matsuda, Shinya3
  • Koike, Kazuhiko1
  • 1 The University of Tokyo, Department of Gastroenterology, Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan , Tokyo (Japan)
  • 2 The University of Tokyo, Department of Health Management and Policy, Graduate School of Medicine, Tokyo, Japan , Tokyo (Japan)
  • 3 University of Occupational and Environmental Health, Department of Preventive Medicine and Community Health, Fukuoka, Japan , Fukuoka (Japan)
Type
Published Article
Journal
Journal of Gastroenterology
Publisher
Springer Japan
Publication Date
Mar 17, 2012
Volume
47
Issue
10
Pages
1125–1133
Identifiers
DOI: 10.1007/s00535-012-0569-0
Source
Springer Nature
Keywords
License
Yellow

Abstract

BackgroundReported mortalities and morbidities of therapeutic procedures for liver tumors vary between studies, because of different designs and small sample sizes. We investigated the mortalities and complication rates for hepatectomy, radiofrequency ablation (RFA), and trans-catheter arterial embolization (TAE) for hepatocellular carcinoma (HCC) in a large sample, using a nationwide Japanese database (the Diagnosis Procedure Combination database).MethodsData from the Diagnosis Procedure Combination database were analyzed for July 1 to December 31, 2007 and the same period in 2008. We identified 54,145 patients with HCC who underwent hepatectomy (n = 5,270), RFA (n = 11,688), or TAE (n = 37,187). In-hospital mortality and morbidity were analyzed for each procedure. The relationships between mortality and factors including patient characteristics and procedural backgrounds were assessed.ResultsIn-hospital mortalities associated with hepatectomy, RFA, and TAE were 2.6 % [95 % confidence interval (CI) 2.2–3.1], 0.3 % (0.2–0.4), and 1.0 % (0.9–1.1), and post-procedural complication rates were 14.5 % (13.5–15.5), 4.5 % (4.2–4.9), and 4.5 % (4.3–4.7), respectively. Increased mortality following hepatectomy was significantly associated with older age, extended lobectomy (vs. partial hepatectomy; odds ratio [OR] 3.80, p < 0.001), lower hospital volume (OR 2.74, p < 0.001), and renal comorbidity (OR 3.01, p = 0.02). Older age and cardiac comorbidity (OR 5.14, p = 0.001) were significantly associated with RFA-related mortality, and lower hospital volume was significantly associated with TAE-related mortality (OR 1.60, p < 0.001).ConclusionsMortalities and morbidities associated with therapeutic procedures for liver tumors were acceptably low in Japan, but were affected by patient and institutional characteristics.

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