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

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

^*Corresponding author for this work

Department of Clinical Medicine - The Department of Surgical Gastroenterology

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

1 Citation (Scopus)

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.

Original language	English
Article number	108366
Journal	European Journal of Surgical Oncology
Volume	50
Issue	7
ISSN	0748-7983
DOIs	https://doi.org/10.1016/j.ejso.2024.108366
Publication status	Published - Jul 2024

Keywords

Ablation
Complications
Hepatocellular carcinoma
Technique efficacy

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10.1016/j.ejso.2024.108366

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Klubien, J., Knøfler, L. A., Poulsen, A. R., Larsen, P. N., Pless, T., Knudsen, A. R., Nielsen, S. D., & Pommergaard, H. C. (2024). Technique efficacy and complications after ablation as first surgical intervention for hepatocellular carcinoma: A nationwide database study. European Journal of Surgical Oncology, 50(7), Article 108366. https://doi.org/10.1016/j.ejso.2024.108366

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

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",

author = "Jeanett Klubien and Kn{\o}fler, {Lucas Alexander} and Poulsen, {Andreas Runge} and Larsen, {Peter N{\o}rgaard} and Torsten Pless and Knudsen, {Anders Riegels} and Nielsen, {Susanne Dam} and Pommergaard, {Hans Christian}",

note = "Publisher Copyright: {\textcopyright} 2024 The Authors",

year = "2024",

month = jul,

doi = "10.1016/j.ejso.2024.108366",

language = "English",

volume = "50",

journal = "European Journal of Surgical Oncology",

issn = "0748-7983",

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Technique efficacy and complications after ablation as first surgical intervention for hepatocellular carcinoma: A nationwide database study. / Klubien, Jeanett; Knøfler, Lucas Alexander; Poulsen, Andreas Runge et al.
In: European Journal of Surgical Oncology, Vol. 50, No. 7, 108366, 07.2024.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

TY - JOUR

T1 - Technique efficacy and complications after ablation as first surgical intervention for hepatocellular carcinoma

T2 - A nationwide database study

AU - Klubien, Jeanett

AU - Knøfler, Lucas Alexander

AU - Poulsen, Andreas Runge

AU - Larsen, Peter Nørgaard

AU - Pless, Torsten

AU - Knudsen, Anders Riegels

AU - Nielsen, Susanne Dam

AU - Pommergaard, Hans Christian

PY - 2024/7

Y1 - 2024/7

N2 - 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.

AB - 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.

KW - Ablation

KW - Complications

KW - Hepatocellular carcinoma

KW - Technique efficacy

UR - http://www.scopus.com/inward/record.url?scp=85191518905&partnerID=8YFLogxK

U2 - 10.1016/j.ejso.2024.108366

DO - 10.1016/j.ejso.2024.108366

M3 - Journal article

C2 - 38692100

AN - SCOPUS:85191518905

SN - 0748-7983

VL - 50

JO - European Journal of Surgical Oncology

JF - European Journal of Surgical Oncology

IS - 7

M1 - 108366

ER -

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

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