Rupture of primary hepatocellular carcinoma after transcatheter arterial chemoembolization：report ;of 8 cases / 介入放射学杂志

ABSTRACT

Objective To summarize the risk factors, the diagnostic and therapeutic approaches, and the outcomes of the ruptured primary hepatocellular carcinoma (PHC) occurred after transcatheter arterial chemoembolization (TACE) in order to make a further understanding of this complication. Methods The clinical data of 8 patients with ruptured PHC after TACE, who were encountered at the First Affiliated Hospital of Suzhou University during the period from Sep. 2007 to Sep. 2013, were retrospectively analyzed. Results A total of 1379 times of TACE were performed in 678 patients with PHC. Among the 678 patients, 8 developed rupture of PHC with bleeding after TACE. The overall incidence was 1.2%. The mean diameter of the tumors in the 8 patients was (11.5 ± 2.6) cm, ranging from 7.6 cm to 15.9 cm. All the lesions were located at the peripheral region close to the liver capsule, and most of them protruded outward. Five cases had coexisting portal hypertension. The average dosage of Lipiodol used in TACE was (14.9 ± 4.5) ml with a range of (8 - 20) ml. Of the 8 patients, emergency transcatheter embolization was carried out in 4 and medical management was employed in other 4. Seven patients died as all active emergency treatments failed. Only one patient, who had received emergency transcatheter embolization, survived the ruptured PHC. Conclusion Rupture of primary hepatocellular carcinoma after TACE is a rare, but very serious complication. Its occurrence may be related to lesion’s characteristics, such as large tumor size, superficial location and protrusion from the liver surface, etc. Besides, interventional management, e.g. without use of solid embolic material to enhance the embolization effect, may also be responsible for the rupture.