Clinical outcomes and cost of open, laparoscopic, and percutaneous ablation for hepatocellular carcinoma.
ablation
cost
hepatocellular carcinoma
outcomes
Journal
Journal of surgical oncology
ISSN: 1096-9098
Titre abrégé: J Surg Oncol
Pays: United States
ID NLM: 0222643
Informations de publication
Date de publication:
Oct 2023
Oct 2023
Historique:
revised:
28
04
2023
received:
12
02
2023
accepted:
11
06
2023
medline:
11
9
2023
pubmed:
3
7
2023
entrez:
3
7
2023
Statut:
ppublish
Résumé
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. 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. 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. 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.
Sections du résumé
BACKGROUND
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
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
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
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.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
812-822Informations de copyright
© 2023 Wiley Periodicals LLC.
Références
Livraghi T, Meloni F, Di Stasi M, et al. Sustained complete response and complications rates after radiofrequency ablation of very early hepatocellular carcinoma in cirrhosis: is resection still the treatment of choice? Hepatology. 2008;47(1):82-89.
Mazzaferro V, Battiston C, Perrone S, et al. Radiofrequency ablation of small hepatocellular carcinoma in cirrhotic patients awaiting liver transplantation: a prospective study. Ann Surg. 2004;240(5):900-909.
Poon RT. Is radiofrequency ablation the treatment of choice for patients with small hepatocellular carcinoma? Nat Clin Pract Gastroenterol Hepatol. 2008;5(9):492-493.
Chen M-S, Li J-Q, Zheng Y, et al. A prospective randomized trial comparing percutaneous local ablative therapy and partial hepatectomy for small hepatocellular carcinoma. Ann Surg. 2006;243(3):321-328.
Huang J, Yan L, Cheng Z, et al. A randomized trial comparing radiofrequency ablation and surgical resection for HCC conforming to the Milan criteria. Ann Surg. 2010;252(6):903-912.
Ng KKC, Chok KSH, Chan ACY, et al. Randomized clinical trial of hepatic resection versus radiofrequency ablation for early-stage hepatocellular carcinoma. Br J Surg. 2017;104(13):1775-1784.
Kudo M, Hasegawa K, Kawaguchi Y, et al. A multicenter randomized controlled trial to evaluate the efficacy of surgery versus radiofrequency ablation for small hepatocellular carcinoma (SURF trial): analysis of overall survival. J Clin Oncol. 2021;39(15_suppl):4093.
Takayama T, Hasegawa K, Izumi N, et al. Surgery versus radiofrequency ablation for small hepatocellular carcinoma: a randomized controlled trial (SURF Trial). Liver Cancer. 2022;11(3):209-218.
Cassera MA, Potter KW, Ujiki MB, Swanström LL, Hansen PD. Computed tomography (CT)-guided versus laparoscopic radiofrequency ablation: a single-institution comparison of morbidity rates and hospital costs. Surg Endosc. 2011;25(4):1088-1095.
Bonastre J, De Baère T, Elias D, et al. Cost of radiofrequency ablation in the treatment of hepatic malignancies. Gastroenterol Clin Biol. 2007;31(10):828-835.
Ding H, Su M, Zhu C, Wang L, Zheng Q, Wan Y. CT-guided versus laparoscopic radiofrequency ablation in recurrent small hepatocellular carcinoma against the diaphragmatic dome. Sci Rep. 2017;7(1):44583.
Della Corte A, Ratti F, Monfardini L, et al. Comparison between percutaneous and laparoscopic microwave ablation of hepatocellular carcinoma. Int J Hyperthermia. 2020;37(1):542-548.
Okawa K, Hagiwara N, Yokoyama T, et al. Percutaneous and laparoscopic approaches of radiofrequency ablation treatment for liver cancer. J Hepatobiliary Pancreat Surg. 2003;10(6):425-427.
Eun HS, Lee BS, Kwon IS, et al. Advantages of laparoscopic radiofrequency ablation over percutaneous radiofrequency ablation in hepatocellular carcinoma. Dig Dis Sci. 2017;62(9):2586-2600.
Song I, Chun K, Kim S. Advantages of laparoscopic radiofrequency ablation over percutaneous radiofrequency ablation in hepatocellular carcinoma. HPB. 2018;20:S383-S384.
Berger NG, Herren JL, Liu C, et al. Ablation approach for primary liver tumors: peri-operative outcomes. J Surg Oncol. 2018;117(7):1493-1499.
Yun D, Kim S, Song I, Chun K. Comparative analysis of Laparoscopic versus open surgical radiofrequency ablation for malignant liver tumors. Korean J Hepatobiliary Pancreat Surg. 2014;18(4):122-128.
Topal B, Hompes D, Aerts R, Fieuws S, Thijs M, Penninckx F. Morbidity and mortality of laparoscopic vs. open radiofrequency ablation for hepatic malignancies. Eur J Surg Oncol. 2007;33(5):603-607.
Sakoda M, Ueno S, Iino S, et al. Endoscopic versus open radiofrequency ablation for treatment of small hepatocellular carcinoma. World J Surg. 2013;37(3):597-601.
Wong J, Lee KF, Yu SCH, et al. Percutaneous radiofrequency ablation versus surgical radiofrequency ablation for malignant liver tumours: the long-term results. HPB. 2013;15(8):595-601.
Agency for Healthcare Research and Quality.Healthcare Cost and Utilization Project. Agency for Healthcare Research and Quality; 2006.
Steiner C, Elixhauser A, Schnaier J. The healthcare cost and utilization project: an overview. Effect Clin Pract. 2002;5(3):143-151.
Whalen D, Houchens R, Elixhauser A. HCUP nationwide inpatient sample (NIS) comparison report. HCUP Methods Series; 2004. https://www.ahrq.gov
Agency for Healthcare Research and Quality.Healthcare Cost and Utilization Project (HCUP). Agency for Healthcare Research and Quality; 2019.
Cost H, Project U, Agency for Healthcare Research and Quality. Advancing Excellence in Health Care. Agency for Healthcare Research and Quality; 2018.
Zhang F, Wu G, Sun H, et al. Radiofrequency ablation of hepatocellular carcinoma in elderly patients fitting the Milan criteria: a single centre with 13 years experience. Int J Hyperthermia. 2014;30(7):471-479.
Odisio BC, Simoneau E, Holmes AA, Conrad CH, Vauthey JN. Fast-track two-stage hepatectomy using a hybrid interventional radiology/operating suite as alternative option to associated liver partition and portal vein ligation for staged hepatectomy procedure. J Am Coll Surg. 2018;227(2):e5-e10.
Cooper MA, Hutfless S, Segev DL, Ibrahim A, Lyu H, Makary MA. Hospital level under-utilization of minimally invasive surgery in the United States: retrospective review. BMJ. 2014;349:g4198.
Current Diagnostic Radiology Programs with an ACGME Approved ESIR Designation; 2022. https://www.sirweb.org/learning-center/ir-residency/esir/