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

  • Original Article—Liver, Pancreas, and Biliary Tract
  • Published:
Journal of Gastroenterology Aims and scope Submit manuscript

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).

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Masaya Sato, Ryosuke Tateishi, Haruhiko Yoshida & Kazuhiko Koike

  2. Department of Health Management and Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

    Hideo Yasunaga & Hiromasa Horiguchi

  3. Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, Fukuoka, Japan

    Shinya Matsuda

Authors
  1. Masaya Sato
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  2. Ryosuke Tateishi
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  3. Hideo Yasunaga
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  4. Hiromasa Horiguchi
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  5. Haruhiko Yoshida
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Correspondence to Ryosuke Tateishi.

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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

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