Article, 2024

Technique efficacy and complications after ablation as first surgical intervention for hepatocellular carcinoma: A nationwide database study

European Journal of Surgical Oncology, ISSN 0748-7983, 1532-2157, Volume 50, 7, Page 108366, 10.1016/j.ejso.2024.108366

Contributors

Klubien, Jeanett 0000-0003-3603-3958 [1] [2] Knøfler, Lucas Alexander [1] [2] Poulsen, Andreas Runge [1] Larsen, Peter Nørgaard 0000-0001-8094-4463 [1] Pless, Torsten Kjaerulf [3] Knudsen, Anders Riegels [4] Nielsen, Susanne Dam 0000-0001-6391-7455 [1] [2] Pommergaard, Hans-Christian Lykkegaard 0000-0001-7068-1946 (Corresponding author) [1] [2]

Affiliations

  1. [1] Rigshospitalet
    2. [NORA names: Capital Region of Denmark; Hospital; Denmark; Europe, EU; Nordic; OECD];
  2. [2] University of Copenhagen
    3. [NORA names: KU University of Copenhagen; University; Denmark; Europe, EU; Nordic; OECD];
  3. [3] Odense University Hospital
    4. [NORA names: Region of Southern Denmark; Hospital; Denmark; Europe, EU; Nordic; OECD];
  4. [4] Aarhus University Hospital
    5. [NORA names: Central Denmark Region; Hospital; Denmark; Europe, EU; Nordic; OECD]

Abstract

INTRODUCTION: Despite limited evidence, technique efficacy and complications may be important short-term outcomes after ablation for hepatocellular carcinoma (HCC). We aimed to report these outcomes after ablation as the first surgical intervention for HCC. METHODS: This nationwide cohort study was based on data from the Danish Liver and Biliary Duct Cancer Database and medical records. Variables associated with outcomes were investigated using logistic regression. RESULTS: From 2013 to 2023, 433 patients were included of which 79% were male, 73% had one tumor, and 90% had cirrhosis. Complete ablation was achieved after percutaneous, laparoscopic, and open approach in 84%, 100%, and 96% of the procedures, respectively. Most patients did not experience complications (76%). Open ablation compared with percutaneous was associated with higher risk of complications in multivariable adjusted analysis (Clavien-Dindo grade 2-5 (odds ratio 5.34, 95% confidence interval [2.36; 12.08]) and 3B-5 (5.70, [2.03; 16.01]), and lower risk of incomplete ablation (0.19 [0.05; 0.65]). Number of tumors ≥3 was associated with a higher risk of incomplete ablation (3.88, [1.45; 10.41]). Tumor diameter ≥3 cm was associated with increased risk of complications grade 2-5 (2.84, [1.29; 6.26]) and 3B-5 (4.44, [1.62; 12.13]). Performance status ≥2 was associated with risk of complications grade 3B-5 (5.98, [1.58; 22.69]). Tumor diameter was not associated with technique efficacy. CONCLUSION: Open ablation had a higher rate of complete ablation compared with percutaneous but was associated with a higher risk of complications. Tumor diameter ≥3 cm and performance status ≥2 were associated with a higher risk of complications.

Keywords

Adjusted analyses, Biliary, Cancer Database, Danish, ablation, analysis, associated with higher risk, associated with higher risk of complications, carcinoma, cirrhosis, cohort study, complete ablation, complications, data, database, database study, efficacy, evidence, hepatocellular, hepatocellular carcinoma, high risk of complications, intervention, liver, logistic regression, male, medical records, multivariable adjusted analyses, nationwide cohort study, nationwide database study, open ablation, outcomes, patients, procedure, records, regression, risk of complications, short-term outcomes, study, surgical intervention, technique, technique efficacy, tumor, variables, variables associated with outcome

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