Abstract
This study aimed to explore the special efforts required to achieve proficiency in performing thermal ablation of liver cancers, including tumors in difficult locations, and clarify the effects of handing-down teaching on the corresponding process. Major complications of patients receiving percutaneous thermal ablation of liver cancer were analyzed. Polynomial fitting was used to describe the connection between major complication rates and special experience. Learning curve of major complications was plotted both for the whole group and for each operator, respectively. Tumors in difficult locations were further studied. A total of 4,363 thermal ablation sessions were included in this study. 143 of 4,363 patients had major complications, corresponding to an incidence rate of 3.27%. 806 thermal ablation sessions were performed for tumors in difficult locations. The major complication rate of these sessions is 6.33%. According to the trend of the learning curve of the 4363 patients, the experience of the whole group can be classified into five stages, that is, the high-risk, relatively stable, unstable, proficient and stable periods. A learning curve for an individual operator can be classified into the high-risk, proficient and stable periods. The major complication rates for the chronologically first, second and third operator of the group are 3.23, 3.35, and 3.31%, respectively. The special experience needed to bypass the first stage corresponds to 410, 510, and 440 sessions, the second stage, 1850, 850, and 870 sessions, by the three operators, respectively. The major complication rates for the tumors in difficult locations for the first, second and third operator were 7.04, 5.53, and 5.98%, respectively. For the tumors in difficult locations, the special experience needed to bypass the first stage corresponds to 150, 130, and 140 sessions, the second stage, 290, 175, and 185 sessions, by the three operators, respectively. In conclusion, the learning process of an operator percutaneous thermal ablation for liver cancer can be classified into three stages. The major complication rate for tumors in difficult locations were higher than that for all tumors. Handing-down teaching can make an operator arrive at the third stage earlier but not the second stage.
Highlights
Local thermal ablation techniques—including radiofrequency ablation, microwave ablation, laser ablation, and high intensity focused ultrasound (HIFU)—is widely used for the treatment of liver tumors in clinical practice [1,2,3]
A total of 4,363 patients undergoing percutaneous thermal ablation were included in this study. 143 of 4,363 patients had major complications with an incidence rate of 3.27% (Table 1)
The major complication rate of our central for the 4,363 radical thermal ablations of liver cancers was 3.27%, similar to those reported in previous studies [9, 22]
Summary
Local thermal ablation techniques—including radiofrequency ablation, microwave ablation, laser ablation, and high intensity focused ultrasound (HIFU)—is widely used for the treatment of liver tumors in clinical practice [1,2,3]. Patients with liver cancer benefit significantly from the minimally invasive therapy. Previous studies show that the long-term outcome of patients treated by thermal ablation is comparable with that of surgical resection [6, 7]. The major complications and perioperative mortality, were significantly lower in patients undergoing local thermal ablation [8, 9]. Major complication is a highly concerned evaluating indicator for thermal ablation. Previous studies found that the rate of complication for thermal ablation ranges from 1.3 to 10.0% [10,11,12,13]. Similar to other minimally invasive treatments, thermal ablation for liver cancers is experience-dependent
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