Ruptured hepatocellular carcinoma as a complication of transarterial oily chemoembolization.
BACKGROUND
Transarterial oily chemoembolization (TOCE) is frequently employed as a non-operative treatment for hepatocellular carcinoma (HCC). Serious complications of TOCE are well known but ruptured HCC as a fatal complication of TOCE has not been reported previously.


METHODS
A retrospective study was performed on all patients who received TOCE for treatment of HCC from January 1989 to October 1996; the complication of ruptured HCC within 2 weeks from the procedure was recorded.


RESULTS
During the study period, 391 patients received a total of 1443 sessions of TOCE (mean 3.7 sessions per patient) for the treatment of HCC, with an overall median survival of 10.4 months. Six patients developed ruptured tumour within 2 weeks after TOCE, resulting in an overall incidence of 1.5 per cent per patient or 0.4 per cent per procedure. All except one patient died 1-25 days after tumour rupture. Factors common to these six patients included: (1) male sex; (2) large tumour size (range 8-17 cm in diameter); (3) tumour located in the right lobe of the liver; (4) tumour ruptured after the first session of TOCE; and (5) TOCE performed as primary treatment without previous hepatic resection.


CONCLUSIONS
Ruptured HCC is a serious complication of TOCE although the incidence is low. It occurred predominantly in men after the first session of TOCE for a large irresectable tumour of the right lobe.
Liu
C L
CL
Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong.
Ngan
H
H
Lo
C M
CM
Fan
S T
ST
D006528:Carcinoma, Hepatocellular / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects* / Q000379:methods; D002945:Cisplatin / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009821:Oils / Q000009:adverse effects*; D012189:Retrospective Studies; D012422:Rupture, Spontaneous / Q000209:etiology
D009821:Oils; D002945:Cisplatin