ORIGINAL ARTICLE—LIVER, PANCREAS, AND BILIARY TRACT Mortality and morbidity of hepatectomy, radiofrequency ablation, and embolization for hepatocellular carcinoma: a national survey of 54,145 patients Masaya Sato • Ryosuke Tateishi • Hideo Yasunaga • Hiromasa Horiguchi • Haruhiko Yoshida • Shinya Matsuda • Kazuhiko Koike Received: 29 September 2011 / Accepted: 21 February 2012 / Published online: 17 March 2012 Ó Springer 2012 Abstract Background Reported mortalities and morbidities of therapeutic procedures for liver tumors vary between stud- ies, because of different designs and small sample sizes. We investigated the mortalities and complication rates for hep- atectomy, radiofrequency ablation (RFA), and trans-catheter arterial embolization (TAE) for hepatocellular carcinoma (HCC) in a large sample, using a nationwide Japanese database (the Diagnosis Procedure Combination database). Methods Data from the Diagnosis Procedure Combination database were analyzed for July 1 to December 31, 2007 and the same period in 2008. We identified 54,145 patients with HCC who underwent hepatectomy (n = 5,270), RFA (n = 11,688), or TAE (n = 37,187). In-hospital mortality and morbidity were analyzed for each procedure. The relationships between mortality and factors including patient characteristics and procedural backgrounds were assessed. Results In-hospital mortalities associated with hepatec- tomy, RFA, and TAE were 2.6 % [95 % confidence interval (CI) 2.2–3.1], 0.3 % (0.2–0.4), and 1.0 % (0.9–1.1), and post-procedural complication rates were 14.5 % (13.5– 15.5), 4.5 % (4.2–4.9), and 4.5 % (4.3–4.7), respectively. Increased mortality following hepatectomy was signifi- cantly associated with older age, extended lobectomy (vs. partial hepatectomy; odds ratio [OR] 3.80, p \ 0.001), lower hospital volume (OR 2.74, p \ 0.001), and renal comorbidity (OR 3.01, p = 0.02). Older age and cardiac comorbidity (OR 5.14, p = 0.001) were significantly associated with RFA-related mortality, and lower hospital volume was significantly associated with TAE-related mortality (OR 1.60, p \ 0.001). Conclusions Mortalities and morbidities associated with therapeutic procedures for liver tumors were acceptably low in Japan, but were affected by patient and institutional characteristics. Keywords Liver tumor Á Hospital volume Á Nationwide database Abbreviations RFA Radiofrequency ablation TAE Trans-catheter arterial embolization DPC Diagnosis Procedure Combination ICD-10 International Classification of Diseases and Related Health Problems, Tenth Revision Introduction The liver is one of the commonest sites of primary and metastatic tumors [1, 2]. Hepatectomy has been considered as a treatment of choice in patients with liver tumors, and can offer survival for 5 years in 50–70 % of patients with early hepatocellular carcinoma (HCC) [3–7], and in M. Sato Á R. Tateishi (&) Á H. Yoshida Á K. Koike Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan e-mail: tateishi-tky@umin.ac.jp H. Yasunaga Á H. Horiguchi Department of Health Management and Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan S. Matsuda Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, Fukuoka, Japan 123 J Gastroenterol (2012) 47:1125–1133 DOI 10.1007/s00535-012-0569-0