Outpatient Transarterial Chemoembolization of Hepatocellular Carcinoma: Review of a Same-Day Discharge Strategy

Fritsche, Micah R.; Watchmaker, Jennifer M.; Lipnik, Andrew J.; Baker, Jennifer; Geevarghese, Sunil K.; Banovac, Filip; Omary, Reed A.; Brown, Daniel B.

doi:10.1016/j.jvir.2017.11.018

Cited by 13 publications

(5 citation statements)

References 19 publications

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“…Successive generations of therapies have evolved from this principle by also delivering chemotherapeutic, known as transarterial chemoembolization (TACE), and radiotherapeutic, known as selective internal radiation therapy (SIRT), agents. From a clinical perspective, transcatheter arterial embolization therapies can be performed as an outpatient procedure, under moderate conscious sedation or general anesthesia, reserving overnight admission in cases of extensive comorbidity, complication, or for management of substantial periprocedural symptomatology [7,8]. Embolization may be repeated multiple times for local tumor control.…”

Section: Technical Overviewmentioning

confidence: 99%

Embolotherapeutic Strategies for Hepatocellular Carcinoma: 2020 Update

Kishore

Bajwa

Madoff

2020

Cancers

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Hepatocellular carcinoma (HCC) represents a significant contributor to cancer-related morbidity and mortality with increasing incidence in both developing and developed countries. Embolotherapy as a locoregional therapeutic strategy consists of trans-arterial or “bland” embolization (TAE), trans-arterial chemoembolization (TACE), and selective internal radiotherapy (SIRT). Trans-catheter arterial therapies can be applied along all stages of HCC, either as an alternative or neoadjuvant to surgical resection/transplantation in very early and early stage HCC or as a palliative option for local disease control in unresectable and advanced stage HCC. In advanced stage HCC, SIRT did not demonstrate superiority in comparison to systemic treatment options in several recent large prospective trials, though for carefully selected patients, may confer improved tolerability with similar disease control rates. The latest embolotherapeutic techniques and literature as they pertain to the management of HCC, as well as future directions, are reviewed in this article.

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Section: Technical Overviewmentioning

confidence: 99%

Embolotherapeutic Strategies for Hepatocellular Carcinoma: 2020 Update

Kishore

Bajwa

Madoff

2020

Cancers

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“…Fritshce et al performed a similar comparison between readmissions after same-day discharge versus overnight observation. The 30-day readmission rate was slightly higher among the same-day discharge (13.8%) group compared to overnight observation (9%) but this was not significant (p = 0.33) [13]. Another retrospective analysis from 2016 showed a similar rate of 4.2% over a 21-year period [14].…”

Section: Discussionmentioning

confidence: 86%

Outcomes and Predictors of 30-Day Readmission in Patients with Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization between 2016 and 2018

Fatima,

Ahmed,

Mohamed

et al. 2024

Gastroenterology Insights

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Background: Hepatocellular carcinoma (HCC) is the third leading cause of cancer death worldwide. The 5-year survival rate for liver cancer in the US has improved from 3% four decades ago to 20% now. Transarterial chemoembolization (TACE) is the treatment of choice for stage B/intermediate-stage HCC. Complications of TACE include hepatic encephalopathy, liver failure, post-embolization syndrome, duodenal ulcers, liver abscesses, acute cholecystitis, and injury to the biliary tract. This study evaluates the 30-day readmission rate and predictors of readmission among patients with HCC undergoing TACE. Methods: The 2016–2018 Healthcare Cost and Utilization Project (HCUP) database, which includes the National Readmission Database (NRD), was used. All adult patients with HCC who underwent TACE were identified using the International Classification of Diseases (ICD-10). The rate of 30-day readmissions after TACE and the associated diagnoses were identified. Logistic regression was used to obtain adjusted odds ratios for variables associated with 30-day readmission. Results: A total of 566 patients underwent TACE between 2016–2018. Sixty-five patients were excluded due to death and unavailability of 30-day readmission data. The procedure was performed in large (80.4%), metro-teaching hospitals (94.5%). Mean patient age was 65.1 ± 9.9 years, and 74% of patients were male. Among the 501 patients, 81 (16.2%) were readmitted within 30 days. The mean age for readmitted patients was 63.2 ± 11.0 and 69.1% were male. The mean length of stay at readmission was 5.5 ± 7.3 days. A total of 7.4% of patients had neurological disorders, 17.3% had weight loss, 30.9% had fluid and electrolyte imbalance, and 21.0% had hepatic encephalopathy. The most common primary diagnoses at 30-day readmission were liver cell carcinoma, sepsis, and liver failure. Univariate analysis for variables associated with 30-day readmission included hepatic encephalopathy (OR 3.45; 95% CI 1.8–6.62; p = 0.0002), underlying neurological disorders (OR 3.28; 95% CI 1.16–9.3; p = 0.03), weight loss (OR 2.82; 95% CI 1.42–5.61; p = 0.003), and Medicaid status (OR 1.74; 95% CI 1.05–2.88; p = 0.03). Multivariable analysis showed hepatic encephalopathy (OR 2.91; 95% CI 1.4, 6.04; p = 0.04) and weight loss (OR 2.37; 95% CI 1.13–4.96; p = 0.02) were associated with hospital readmission. Conclusions: Weight loss and hepatic encephalopathy were predictors for 30-day readmission after a TACE procedure for HCC.

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“…Early diagnosis of HCC allows for earlier treatment with favorable outcomes, which translates into reduced complications associated with HCC and hence decreased hospitalizations. As a bridge to transplant or as palliation in advanced stages of HCC, transarterial chemoembolization (TACE) can be performed and recent single-center studies suggest that these patients can safely be discharged home after the procedure without the need for overnight hospitalization [35][36][37][38]. Thus, there may have been a trend towards performing this procedure on an outpatient basis in the latter part of the study period, thereby leading to the significant decline in the HCC hospitalization rate observed in this study.…”

Section: Discussionmentioning

confidence: 88%

Epidemiology and Outcomes of Hospitalizations Due to Hepatocellular Carcinoma

Mullangi¹,

Keesari²,

Zaher³

et al. 2021

Cureus

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BackgroundHepatocellular Carcinoma (HCC) is a severe complication of cirrhosis and the incidence of HCC has been increasing in the United States (US). We aim to describe the trends, characteristics, and outcomes of hospitalizations due to HCC across the last decade. MethodsWe derived a study cohort from the Nationwide Inpatient Sample (NIS) for the years 2008-2017. Adult hospitalizations due to HCC were identified using the International Classification of Diseases (9th/10th Editions) Clinical Modification diagnosis codes (ICD-9-CM/ICD-10-CM). Comorbidities were also identified by ICD-9/10-CM codes and Elixhauser Comorbidity Software (Agency for Healthcare Research and Quality, Rockville, Maryland, US). Our primary outcomes were in-hospital mortality and discharge to the facility. We then utilized the Cochran-Armitage trend test and multivariable survey logistic regression models to analyze the trends, outcomes, and predictors.

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Outpatient Transarterial Chemoembolization of Hepatocellular Carcinoma: Review of a Same-Day Discharge Strategy

Cited by 13 publications

References 19 publications

Embolotherapeutic Strategies for Hepatocellular Carcinoma: 2020 Update

Embolotherapeutic Strategies for Hepatocellular Carcinoma: 2020 Update

Outcomes and Predictors of 30-Day Readmission in Patients with Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization between 2016 and 2018

Epidemiology and Outcomes of Hospitalizations Due to Hepatocellular Carcinoma

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