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Vega EA, Agudile E, Salirrosas O, Chirban AM, Brauner E, Crocker A, Freeman R, Sorescu GP, Odisio BC, Conrad C. Clinical outcomes and cost of open, laparoscopic, and percutaneous ablation for hepatocellular carcinoma. J Surg Oncol 2023; 128:812-822. [PMID: 37395114 DOI: 10.1002/jso.27377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 04/28/2023] [Accepted: 06/11/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND Open (OA), laparoscopic (LA), and percutaneous (PA) ablation are all ablation approaches for hepatocellular carcinoma (HCC) utilized in the United States today. However, it remains unclear today which approach is (A) most effective, (B) cost-efficient, and (C) nationally practiced. METHODS In-hospital mortality and cost were collected from the National Inpatient Sample (NIS) database for patients undergoing liver ablation from 2011 to 2018. Secondary outcomes included length of stay, disposition, and perioperative composite complications. We used inverse probability of treatment weighting (IPTW) to adjust for differences in patient and hospital baseline characteristics. RESULTS One thousand and one hundred and twenty-five LA, 1221 OA, and 1068 PA liver ablations were analyzed. After IPTW, in-hospital mortality risk was significantly lower in PA versus OA cohorts (0.57% vs. 2.90%, p < 0.001) and reduced among PA patients, yet not significantly different from the LA cohort (0.57% vs. 1.64%, p = 0.056). The median length of hospital stay was significantly lower in the PA and LA group compared to OA (2 days vs. 6 days, p < 0.001). The median hospitalization costs were significantly lower for PA ($44,884 vs. $90,187, p < 0.001) and LA ($61,445 vs. $90,187, p < 0.001) compared to OA. Moreover, we found significant regional differences regarding the use of each ablation approach, with the Midwest having the lowest rates of PA and LA. CONCLUSIONS Among patients hospitalized after ablation for HCC, PA leads to the lowest hospital cost. Both PA and LA result in lower peri-operative morbidity and mortality relative to OA. Despite these reported advantages, there are significant regional differences with respect to ablation availability suggesting the need to promote the standardization of best practices.
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Affiliation(s)
- Eduardo A Vega
- Department of Surgery, St. Elizabeth's Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Emeka Agudile
- Department of Medicine, Steward Carney Hospital, Dorchester, Massachusetts, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Oscar Salirrosas
- Department of Surgery, St. Elizabeth's Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Ariana M Chirban
- Department of Surgery, St. Elizabeth's Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
- School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Eran Brauner
- Department of Surgery, St. Elizabeth's Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Andrew Crocker
- Department of Surgery, St. Elizabeth's Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Richard Freeman
- Department of Surgery, St. Elizabeth's Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - George P Sorescu
- Department of Medicine, Steward Carney Hospital, Dorchester, Massachusetts, USA
| | - Bruno C Odisio
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Claudius Conrad
- Department of Surgery, St. Elizabeth's Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
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Yamao T, Imai K, Yamashita YI, Umezaki N, Tsukamoto M, Kitano Y, Arima K, Miyata T, Nakagawa S, Okabe H, Nitta H, Chikamoto A, Ishiko T, Baba H. Thoracoscopic surgery for hepatocellular carcinoma located in the hepatic dome: Technical aspect and oncological results. Asian J Endosc Surg 2020; 13:375-381. [PMID: 31515954 DOI: 10.1111/ases.12755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 07/19/2019] [Accepted: 08/06/2019] [Indexed: 12/19/2022]
Abstract
INTRODUCTION The objective of this study was to describe the surgical techniques for a thoracoscopic approach to treat hepatocellular carcinoma in the hepatic dome. Also, safety, feasibility, and long-term outcomes were evaluated. METHODS Surgical procedures were selected based on liver function, the extent and location of the tumor, and each patient's general condition. Thoracoscopic hepatic resection was performed under direct vision through a diaphragmatic incision. Thoracoscopic radiofrequency ablation (TRFA) was performed either with a transdiaphragmatic puncture for deeply located tumors or under direct vision through a diaphragmatic incision for subcapsular tumors. RESULTS Thoracoscopic surgery was indicated for 107 patients with hepatocellular carcinoma in the hepatic dome. Among these patients, 5 underwent hepatectomy and 102 underwent radiofrequency ablation, which was more frequently employed in patients with impaired liver function. Of the patients who underwent radiofrequency ablation, 43 (42.2%) required a diaphragmatic incision. In the thoracoscopic hepatic resection group and TRFA group, the median operating time was 350 and 197 minutes, the median blood loss was 200 and 5 mL, and the complication rate was 12.7% and 20.0%, respectively. The 5-year overall and disease-free survival rates were 100% and 50.0% in the thoracoscopic hepatic resection group, respectively, and 60.7% and 18.1% in the TRFA group, respectively. Local recurrence after TRFA was observed in 10 patients (9.8%). CONCLUSION The thoracoscopic approach is safe and feasible, with promising short- and long-term outcomes. It could serve as a treatment option for hepatocellular carcinoma in the hepatic dome.
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Affiliation(s)
- Takanobu Yamao
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Katsunori Imai
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Yo-Ichi Yamashita
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Naoki Umezaki
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Masayo Tsukamoto
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Yuki Kitano
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Kota Arima
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Tatsunori Miyata
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Shigeki Nakagawa
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Hirohisa Okabe
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Hidetoshi Nitta
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Akira Chikamoto
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Takatoshi Ishiko
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
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Girotra M, Soota K, Dhaliwal AS, Abraham RR, Garcia-Saenz-de-Sicilia M, Tharian B. Utility of endoscopic ultrasound and endoscopy in diagnosis and management of hepatocellular carcinoma and its complications: What does endoscopic ultrasonography offer above and beyond conventional cross-sectional imaging? World J Gastrointest Endosc 2018; 10:56-68. [PMID: 29467916 PMCID: PMC5807886 DOI: 10.4253/wjge.v10.i2.56] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 12/28/2017] [Accepted: 01/15/2018] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma constitutes over 90% of the primary liver tumors, the rest being cholangiocarcinoma. It has an insidious presentation, which is responsible for the delayed presentation. Hence, the management strategy relies on screening to diagnose it an early stage for curative resection and/or treatment with local ablative techniques or chemotherapy. However, even with different screening programs, more than 60% of tumors are still detected at an advanced stage, leading to an unchanged mortality rate, thereby implying a room for improvement in the screening and diagnostic process. In the last few years, there has been evolution of utility of endoscopy, specifically endoscopic ultrasonography along with Fine needle aspiration, for this purpose, which we comprehensively review in this article.
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Affiliation(s)
- Mohit Girotra
- Division of Gastroenterology, University of Miami Miller School of Medicine, Miami, FL 33136, United States
| | - Kaartik Soota
- Division of Gastroenterology and Hepatology, University of Iowa School of Medicine, Iowa City, IA 52242, United States
| | - Amaninder S Dhaliwal
- Division of Gastroenterology and Hepatology, University of Nebraska School of Medicine, Omaha, NE 68198, United States
| | - Rtika R Abraham
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL 33136, United States
| | | | - Benjamin Tharian
- Division of Gastroenterology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States
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Yuan W, Yang MJ, Xu J, Yan ZP, Liu R, Qu XD, Wang JH, Qian S. Radiofrequency Ablation Combined With Transarterial Chemoembolization for Specially Located Small Hepatocellular Carcinoma. Technol Cancer Res Treat 2018; 17:1533033818788529. [PMID: 30045673 PMCID: PMC6071156 DOI: 10.1177/1533033818788529] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To investigate the safety and efficacy of radiofrequency ablation combined with transarterial chemoembolization in patients with specially located small hepatocellular carcinoma. MATERIALS AND METHODS Between March 2014 and March 2017, a total of 26 patients with 26 lesions (10 perivascular, 6 subdiaphragmatic, 5 subcapsular, 5 perivascular, and subdiaphragmatic location; mean diameter 2.12 (0.62) cm), who received radiofrequency ablation-transarterial chemoembolization treatment, were retrospectively analyzed. Local tumor response was assessed by computed tomography/magnetic resonance imaging 1 month after the procedure. Tumor-free survival was also assessed according to the modified Response Evaluation Criteria in Solid Tumors. Complications were evaluated according to the National Cancer Institute's Common Terminology Criteria for Adverse Events (version 4.0). RESULTS Complete response was achieved in all patients 1 month after the procedure. During a median follow-up duration of 16.76 months (95% confidence interval: 7.78-25.73 months), local tumor recurrence occurred in 2 patients and new intrahepatic lesions developed in 7 patients. The 1-, 2-, and 3-year cumulative local tumor progression rates were 3.84%, 7.69%, and 7.69%, respectively. The median tumor-free survival duration was 21.96 months (95% confidence interval: 17.58-26.34 months). The 1-, 2-, and 3-year tumor-free survival rates were 67.4%, 46.1%, and 39.3%, respectively. CONCLUSION The radiofrequency ablation-transarterial chemoembolization combination therapy appears to be safe and effective and might be a treatment option for specially located small hepatocellular carcinoma lesions that have a risk of incomplete ablation or major complications.
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Affiliation(s)
- Wei Yuan
- 1 Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.,2 Shanghai Institution of Medical Imaging, Shanghai, China
| | - Min-Jie Yang
- 1 Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.,2 Shanghai Institution of Medical Imaging, Shanghai, China
| | - Jiang Xu
- 3 Department of Rehabilitation, Huai'an Second People's Hospital, The Affiliated Hospital of Xuzhou Medical University, Huai'an, China
| | - Zhi-Ping Yan
- 1 Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.,2 Shanghai Institution of Medical Imaging, Shanghai, China
| | - Rong Liu
- 1 Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.,2 Shanghai Institution of Medical Imaging, Shanghai, China
| | - Xu-Dong Qu
- 1 Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.,2 Shanghai Institution of Medical Imaging, Shanghai, China
| | - Jian-Hua Wang
- 1 Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.,2 Shanghai Institution of Medical Imaging, Shanghai, China
| | - Sheng Qian
- 1 Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.,2 Shanghai Institution of Medical Imaging, Shanghai, China
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Lee JY, Kim YH, Roh YH, Roh KB, Kim KW, Kang SH, Baek YH, Lee SW, Han SY, Kwon HJ, Cho JH. Intraoperative radiofrequency ablation for hepatocellular carcinoma in 112 patients with cirrhosis: a surgeon's view. Ann Surg Treat Res 2016; 90:147-56. [PMID: 26942158 PMCID: PMC4773459 DOI: 10.4174/astr.2016.90.3.147] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 11/16/2015] [Accepted: 11/23/2015] [Indexed: 12/15/2022] Open
Abstract
Purpose This retrospective study was an investigation of overall survival (OS), disease-free survival (DFS) and prognostic factors affecting OS and DFS in cirrhotic patients who received intraoperative radiofrequency ablation (IORFA). Methods Between April 2009 and November 2013, 112 patients (94 men, 84%; 18 women, 16%) underwent IORFA for 185 cases of hepatocellular carcinomas (HCC). Repeat IORFA was done in 9 patients during the same period (total of 121 treatments). Results All patients were followed-up for at least 12 months (mean follow-up, 32 months). Surgical resection combined with IORFA was performed in 20 patients. The technical effectiveness at 1 week was 91.78% (111 of 121). Readmission was 9.1% (11 of 121) and the most common cause was ventral hernia. Procedure-related mortality was 2.7% (3 of 112) and continued fatal biliary leakage was 1.8% (2 of 112). Local recurrence developed in 10 patients (8.9%). Most recurrence was intrahepatic. Cumulative survival was assessed in 33 patients who received IORFA as primary treatment (naive patients) and 79 non-naive patients. The cumulative DFS and OS rate at l and 3 years was 54% and 24%, and 87% and 66%, respectively. Moderate ascites (P = 0.001), tumor located segment I (P = 0.001), portal vein thrombosis (P = 0.001) had poor survival were significant factors by multivariate analysis. Conclusion IORFA alone or in combination with surgical resection extends the spectrum of liver surgery. A fundamental understanding of RFA, additional comorbidities, and postablation complication are necessary to maximize the safety and efficacy of IORFA for treating HCC with cirrhosis.
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Affiliation(s)
- Jung Yeon Lee
- Department of Surgery, Dong-A University College of Medicine, Pusan, Korea
| | - Young Hoon Kim
- Department of Surgery, Dong-A University College of Medicine, Pusan, Korea
| | - Young Hoon Roh
- Department of Surgery, Dong-A University College of Medicine, Pusan, Korea
| | - Kyung Bin Roh
- Department of Surgery, Dong-A University College of Medicine, Pusan, Korea
| | - Kwan Woo Kim
- Department of Surgery, Dong-A University College of Medicine, Pusan, Korea
| | - Sung Hwa Kang
- Department of Surgery, Dong-A University College of Medicine, Pusan, Korea
| | - Yang Hyun Baek
- Department of Internal Medicine, Dong-A University College of Medicine, Pusan, Korea
| | - Sung Wook Lee
- Department of Internal Medicine, Dong-A University College of Medicine, Pusan, Korea
| | - Sang Young Han
- Department of Internal Medicine, Dong-A University College of Medicine, Pusan, Korea
| | - Hee Jin Kwon
- Department of Radiology, Dong-A University College of Medicine, Pusan, Korea
| | - Jin Han Cho
- Department of Radiology, Dong-A University College of Medicine, Pusan, Korea
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A case of small hepatocellular carcinoma treated with laparoscopic multipolar radiofrequency ablation with a no-touch ablation procedure. Clin J Gastroenterol 2014; 7:510-5. [PMID: 25491908 DOI: 10.1007/s12328-014-0531-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 09/28/2014] [Indexed: 12/28/2022]
Abstract
A 77-year-old man with hepatocellular carcinoma was admitted to our institution. Computed tomography revealed two nodules, one at the surface and one within the liver, ≤3 cm in diameter. We performed laparoscopic radiofrequency ablation using a bipolar system with a "no-touch ablation" procedure using multiple applicators for insertion, not into the tumor directly, but to the perimeter of the tumor. A sufficient ablated area was obtained regardless of tumor location. No operative complications were encountered and adequate therapeutic effect was achieved safely. Laparoscopic multipolar radiofrequency ablation is a feasible procedure for treating hepatocellular carcinoma.
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