Technique efficacy and complications after ablation as first surgical intervention for hepatocellular carcinoma: a nationwide database study
Menée à l'aide de données danoises 2013-2023 portant sur 433 patients atteints d'un carcinome hépatocellulaire (79 % hommes), cette étude compare le taux d'ablation complète et les complications en fonction du type de chirurgie réalisée (voie percutanée, ouverte, laparoscopique)
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.