Recent Trends and In-Hospital Mortality of Transarterial Chemoembolization (TACE) in Germany: A Systematic Analysis of Hospital Discharge Data between 2010 and 2019

Abstract

(1) Background: Transarterial chemoembolization (TACE) is a minimally invasive procedure, characterized by the selective occlusion of tumor-feeding hepatic arteries, via injection of an embolizing agent and an anticancer drug. It represents a standard of care for intermediate-stage hepatocellular carcinoma (HCC), and it is also increasingly performed in cholangiocarcinoma (CCA), as well as in liver metastases. Apart from the original method, based on intra-arterial infusion of a liquid drug followed by embolization, newer particle-based TACE procedures have been introduced recently. As yet, comprehensive data on current trends of TACE, as well as its in-hospital mortality in Germany, which could help to further improve outcome following TACE, are missing. (2) Methods: Based on standardized hospital discharge data, provided by the German Federal Statistical Office from 2010 to 2019, we aimed at systematically evaluating current clinical developments and in-hospital mortality related to TACE in Germany. (3) Results: A total of 49,595 individual cases undergoing TACE were identified within the observation period. The overall in-hospital mortality was 1.00% and significantly higher in females compared to males (1.12 vs. 0.93%; p < 0.001). We identified several post-interventional complications, such as liver failure (51.49%), sepsis (33.87%), renal failure (23.9%), and liver abscess (15.87%), which were associated with a significantly increased in-hospital mortality. Moreover, in-hospital mortality significantly differed between the underlying indications for TACE (HCC: 0.83%, liver metastases: 1.22%, and CCA: 1.40%), as well as between different embolization agents (liquid embolization: 0.80%, loaded microspheres: 0.92%, spherical particles: 1.54%, and non-spherical particles: 2.84%), for which we observed large geographic differences in their frequency of use. Finally, in-hospital mortality was significantly increased in centers with a low annual TACE case volume (<15 TACE/year: 2.08% vs. >275 TACE/year: 0.45%). (4) Conclusion: Our data provide a systematic overview of indications and embolization methods for TACE in Germany. We identified a variety of factors, such as post-interventional complications, the embolization method used, and the hospitals’ annual case volume, which are associated with an increased in-hospital mortality following TACE. These data might help to further reduce the mortality of this routinely performed local-ablative procedure in the future.

The Impact of a Liver Transplant Program on the Outcomes of Hepatocellular Carcinoma

“…3A, B). Krieg et al had noted that the incidence of in-hospital mortality after TACE was inversely proportional to procedure volume, and a certain number of procedures (ie, a “learning curve”) was required to improve patient outcomes 34 . In a separate study, Uhlig et al reported that hospital volume was also associated with long-term outcomes among patients treated with RT 4 .…”

Multimodal Conversion Therapy with TACE, Zimberelimab, Lenvatinib and S-1, Followed by Debulking Surgery to Prolong Survival for Gallbladder Cancer with Liver Metastasis: A Case Report

“…A retrospective study showed the overall response rate of repeated TACE with gemcitabine-oxaliplatin was 29.2% in advanced BTC [20]. Meanwhile, TACE is increasingly performed to control local metastatic lesions of liver from various malignant tumors [21], such as colorectal, gastric, breast cancers and neuroendocrine tumors [22][23][24][25]. The attempt is worthy to perform TACE for potentially resectable GBC with liver metastasis.…”