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

Jeanett Klubien; Lucas Alexander Knøfler; Andreas Runge Poulsen; Peter Nørgaard Larsen; Torsten Pless; Anders Riegels Knudsen; Susanne Dam Nielsen; Hans-Christian Pommergaard

doi:10.1016/j.ejso.2024.108366

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

Eur J Surg Oncol. 2024 Apr 24;50(7):108366. doi: 10.1016/j.ejso.2024.108366. Online ahead of print.

Authors

Jeanett Klubien¹, Lucas Alexander Knøfler¹, Andreas Runge Poulsen², Peter Nørgaard Larsen², Torsten Pless³, Anders Riegels Knudsen⁴, Susanne Dam Nielsen⁵, Hans-Christian Pommergaard⁶

Affiliations

¹ Department of Surgery and Transplantation, Rigshospitalet, Copenhagen University Hospital, Inge Lehmanns Vej 7, 2100, Copenhagen, Denmark; Hepatic Malignancy Surgical Research Unit (HEPSURU), Department of Surgery and Transplantation, Rigshospitalet, Inge Lehmanns Vej 7, 2100, Copenhagen, Denmark; Viro-immunology Research Unit, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Esther Møllers Vej 6, 2100, Copenhagen, Denmark.
² Department of Surgery and Transplantation, Rigshospitalet, Copenhagen University Hospital, Inge Lehmanns Vej 7, 2100, Copenhagen, Denmark.
³ Department of Surgery, Odense University Hospital, J. B. Winsløwsvej 4, 5000, Odense C, Denmark.
⁴ Department of Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 35, 8200, Aarhus, Denmark.
⁵ Department of Surgery and Transplantation, Rigshospitalet, Copenhagen University Hospital, Inge Lehmanns Vej 7, 2100, Copenhagen, Denmark; Hepatic Malignancy Surgical Research Unit (HEPSURU), Department of Surgery and Transplantation, Rigshospitalet, Inge Lehmanns Vej 7, 2100, Copenhagen, Denmark; Viro-immunology Research Unit, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Esther Møllers Vej 6, 2100, Copenhagen, Denmark; Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Esther Møllers Vej 6, 2100, Copenhagen, Denmark; Institute for Clinical Medicine, University of Copenhagen, Panum Institute, Blegdamsvej 3B, 2200, Copenhagen, Denmark.
⁶ Department of Surgery and Transplantation, Rigshospitalet, Copenhagen University Hospital, Inge Lehmanns Vej 7, 2100, Copenhagen, Denmark; Hepatic Malignancy Surgical Research Unit (HEPSURU), Department of Surgery and Transplantation, Rigshospitalet, Inge Lehmanns Vej 7, 2100, Copenhagen, Denmark; Viro-immunology Research Unit, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Esther Møllers Vej 6, 2100, Copenhagen, Denmark; Institute for Clinical Medicine, University of Copenhagen, Panum Institute, Blegdamsvej 3B, 2200, Copenhagen, Denmark. Electronic address: hans-christian.pommergaard@regionh.dk.

PMID: 38692100
DOI: 10.1016/j.ejso.2024.108366

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: Ablation; Complications; Hepatocellular carcinoma; Technique efficacy.