Rationale and Objectives
There is lack of information on the learning curve and the effect of operator’s experience on the quality outcomes of transarterial hepatic embolization (TAE). The aim of this study was to evaluate the effect of operator experience on outcomes of TAE of hepatocellular carcinoma.
Materials and Methods
Demographic characteristics and outcomes including overall survival (OS), time to local tumor progression (TLP), and post-procedure complications in patients with hepatocellular carcinoma treated with TAE were collected. Operators’ experience was measured in years based on the years after completion of fellowship and the date of first embolization, and was divided into five groups: G1, less than 5 years of operator’s experience (YOE) at the time of first embolization; G2, 5–10 YOE; G3, 10–15 YOE; G4, 15–20 YOE; and G5, more than 20 YOE. The effects of operator’s experience and outcomes were assessed using linear regression.
Results
From January 2012 to January 2015, 93 patients (age range = 30–86 years) were treated. The number of patients treated by each group was as follows: G1 = 12; G2 = 8; G3 = 23; G4 = 5; and G5 = 45. All groups were similar in regard to degree of cirrhosis, Barcelona Clinic Liver Cancer staging, and Child-Pugh score ( P > .05). Median TLP was 8.8 months. TLP was 7.0, 6.8, 19.2, 7.9, and 8.2 months in G1, G2, G3, G4, and G5, respectively ( P = .56). OS for 1, 2, and 3 years was 75%, 56%, and 42% for G1; 87%, 54%, and 54% for G2; 91%, 71%, and 45% for G3, 100%, 50%, and 0 for G4; and 84%, 65%, and 40% for G5.
Conclusion
Among interventional radiology fellowship-trained operators in a tertiary cancer center, OS, TLP, and post-procedure complications of TAE were not affected by the years of post-fellowship experience.
Introduction
Transarterial hepatic embolization (TAE) and transarterial chemoembolization (TACE) are two minimally invasive procedures that interventional radiologists (IRs) have been using in the past 3–4 decades. Both procedures have been used extensively to treat nonsurgical patients with hepatocellular carcinoma (HCC) . TACE has been shown to be safe and effective in improving the overall survival (OS) when compared to best supportive care through randomized clinical trials . Most recently, in a randomized clinical trial, TAE was compared to doxorubicin-eluting microsphere chemoembolization and the study demonstrated that TAE was as effective and safe as the latter .
The principles of how to perform TAE and TACE are part of the teaching curriculum of any IR fellowship training program. The technical success in most interventions is related to skills that are obtained during training and continue to improve after finishing training and during independent practice. IR fellows are trained on how to use wires, microwires, catheters, and microcatheters. Additionally, IR fellows will get educated on principles of embolization and different embolizing options.
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Materials and Methods
Patient Selection
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Transarterial Hepatic Embolization Procedure
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Operator Experience
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Outcome
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Statistical Analysis
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Results
Demographic Characteristic
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TABLE 1
Demographic Characteristics of the Five Groups of HCC Patients Treated With TAE
G1 G2 G3 G4 G5P__n 12 8 23 5 45 Age (y) 68.7 67.1 65.8 64.2 67.9 .891 Gender Female 2 0 7 2 15 .427 Male 10 8 16 3 30 Cirrhosis .504 No 3 3 7 0 9 Yes 9 5 16 5 36 Child-Pugh score .872 A 12 8 23 5 41 B 0 0 0 0 4 C 0 0 0 0 0 BCLC .833 A 3 2 9 1 16 B 6 4 10 4 18 C 3 2 4 0 11 % Liver involvement .789 <25% 7 6 15 4 28 >25, <50 5 1 5 1 15 >50, <75 0 1 2 0 2 >76–100 0 0 1 0 0 Extrahepatic disease .6 No 12 8 23 5 45 Yes 0 0 0 0 0 Previous surgery .060 Yes 5 4 12 1 9 No 7 4 11 4 36 ECOG .602 0 11 7 22 13 36 1 1 1 0 0 0 2 0 0 0 0 0 3 0 0 0 0 0 Systemic chemotherapy .366 No 11 6 22 5 42 Yes 1 2 1 0 3
BCLC, Barcelona Clinic Liver Cancer; ECOG, Eastern Corporative Oncology Group.
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Technical Aspects
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Outcomes
Local Tumor Progression Free Survival
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Overall Survival
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Complications
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Discussion
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Acknowledgments
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