Hepatobiliary and Pancreatic Surgery Program, Providence Portland Medical Center, 4805 NE Glisan St., Suite 6N50, Portland, OR 97213, USA.
Surg Endosc. 2011 Apr;25(4):1088-95. doi: 10.1007/s00464-010-1322-5. Epub 2010 Sep 17.
Computed tomography (CT)-guided radiofrequency ablation (RFA) is presumed to be less morbid and less costly than laparoscopic RFA. This analysis investigates the 30-day morbidity, hospital cost, and reimbursement for CT-guided RFA versus laparoscopic RFA used to manage hepatocellular carcinoma (HCC) and colorectal liver metastases (CRLM).
A retrospective review was performed for all patients with CRLM or HCC who underwent CT-guided RFA or laparoscopic RFA between January 2002 and August 2008. Demographics, risk stratification, and procedural data were analyzed. Hospital financial data were queried for total cost, reimbursement, and itemized departmental charges. The CRLM and HCC patients were evaluated separately.
The study analyzed 18 RFA procedures for the treatment of HCC (8 CT-guided RFA; 10 laparoscopic RFA) and 25 RFA procedures for the treatment of CRLM (6 CT-guided RFA; 19 laparoscopic RFA). Immediate local failures were reported for 33.3% and 12.5% of the CT-guided RFA procedures for CRLM and HCC and for 5.2% and 0.0% of the laparoscopic RFA procedures for CRLM and HCC, respectively. The mean hospital cost was higher for the patients who underwent laparoscopic RFA ($11,808.70 ± $7,238.90 for HCC vs $9,882.40 ± $1,926.90 for CRLM) than for those who underwent CT-guided RFA ($7,186.10 ± $3,899.60 for HCC vs $5,767.50 ± $2,869.00 for CRLM). The mean reimbursement was lower than the mean hospital cost for the patients who underwent CT-guided RFA for CRLM ($4,329.10 vs $5,767.50).
Although CT-guided RFA is less expensive, it is poorly reimbursed. Also, CT-guided RFA is associated with a higher immediate local failure rate for both CRLM and HCC and a higher complication rate for patients with CRLM. For patients with HCC, CT-guided RFA is associated with a lower complication rate. Our data suggest that laparoscopic RFA should be used for most patients with CRLM and only selectively for patients with HCC.
与腹腔镜射频消融术（RFA）相比，计算机断层扫描（CT）引导的 RFA 假定为创伤更小且费用更低。本分析调查了用于治疗肝细胞癌（HCC）和结直肠癌肝转移（CRLM）的 CT 引导 RFA 与腹腔镜 RFA 的 30 天发病率、住院费用和报销情况。
对 2002 年 1 月至 2008 年 8 月期间接受 CT 引导 RFA 或腹腔镜 RFA 治疗的所有 CRLM 或 HCC 患者进行了回顾性审查。分析了人口统计学，风险分层和程序数据。查询了医院财务数据，以获取总费用，报销和逐项部门收费。分别评估了 CRLM 和 HCC 患者。
本研究分析了 18 例用于治疗 HCC 的 RFA 程序（8 例 CT 引导 RFA；10 例腹腔镜 RFA）和 25 例用于治疗 CRLM 的 RFA 程序（6 例 CT 引导 RFA；19 例腹腔镜 RFA）。报道的 CRLM 和 HCC 的 CT 引导 RFA 程序的即刻局部失败率分别为 33.3％和 12.5％，腹腔镜 RFA 程序的即刻局部失败率分别为 5.2％和 0.0％。接受腹腔镜 RFA 治疗的患者的平均住院费用较高（HCC 为$11808.70 ± $7238.90，CRLM 为$9882.40 ± $1926.90），而接受 CT 引导 RFA 治疗的患者则较低（HCC 为$7186.10 ± $3899.60，CRLM 为$5767.50 ± $2869.00）。接受 CT 引导 RFA 治疗的 CRLM 患者的平均报销额低于平均住院费用（$4329.10 vs $5767.50）。
尽管 CT 引导 RFA 的费用较低，但报销却很差。此外，CT 引导 RFA 与 CRLM 和 HCC 的即刻局部失败率较高以及 CRLM 患者的并发症发生率较高相关。对于 HCC 患者，CT 引导 RFA 与较低的并发症发生率相关。我们的数据表明，腹腔镜 RFA 应适用于大多数 CRLM 患者，而仅选择性地用于 HCC 患者。
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