Abstract
Background
Reported 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).
Methods
Data 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.
Results
In-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).
Conclusions
Mortalities 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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Abbreviations
- RFA:
-
Radiofrequency ablation
- TAE:
-
Trans-catheter arterial embolization
- DPC:
-
Diagnosis Procedure Combination
- ICD-10:
-
International Classification of Diseases and Related Health Problems, Tenth Revision
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Acknowledgments
This work was supported by a Grant-in-Aid for Research on Policy Planning and Evaluation from the Ministry of Health, Labour and Welfare, Japan; and Health Sciences Research Grants of The Ministry of Health, Labour and Welfare (Research on Hepatitis).
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The authors declare that they have no conflict of interest.
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Sato, M., Tateishi, R., Yasunaga, H. et al. Mortality and morbidity of hepatectomy, radiofrequency ablation, and embolization for hepatocellular carcinoma: a national survey of 54,145 patients. J Gastroenterol 47, 1125–1133 (2012). https://doi.org/10.1007/s00535-012-0569-0
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DOI: https://doi.org/10.1007/s00535-012-0569-0