Evaluation of the Effect of Operator Experience on Outcome of Hepatic Artery Embolization of Hepatocellular Carcinoma in a Tertiary Cancer Center

Abstract

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. 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. 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. 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.