Intrahepatic biloma formation (bile duct necrosis) after transcatheter arterial chemoembolization.
OBJECTIVE
The purpose of our study was to discuss the incidence, predisposing factors, and clinical course of intrahepatic biloma after transcatheter arterial chemoembolization for hepatic tumors including hepatocellular carcinoma and metastatic liver tumor.


METHODS
Nine hundred seventy-two patients with hepatocellular carcinoma (n = 920) or metastatic liver tumor (n = 52) underwent chemoembolization during a 12-year period beginning in January 1989. We retrospectively reviewed the medical records and follow-up radiographs of chemoembolization and analyzed the risk factors associated with the development of intrahepatic biloma.


RESULTS
Intrahepatic biloma developed after chemoembolization in 35 patients (3.6%, 35/972) in our series. The incidence of intrahepatic biloma formation in patients with metastatic liver tumor (9.6%, 5/52) was higher than that in patients with hepatocellular carcinoma (3.3%, 30/920) (p < 0.05, Fisher's exact test). The incidence of intrahepatic biloma formation in patients with hepatocellular carcinoma was statistically higher in patients with main tumor size of less than 5 cm and in those with the presence of intrahepatic bile duct dilatation. Technique-related risk factors such as injection site of drugs, repeated chemoembolization with frequency of less than 3 months, and regimen of chemoembolization significantly influenced the incidence of biloma formation in patients with hepatocellular carcinoma. No patient died of infected biloma or septicemia, but one patient died of hepatic failure 2 months after chemoembolization.


CONCLUSIONS
Biloma formation was significantly more prevalent in the metastatic lesion group than in the hepatocellular carcinoma group. Significant prognostic factors for biloma formation in patients with hepatocellular carcinoma were tumor size of less than 5 cm, bile duct dilatation, proximal injection site, repeated injection with frequency of less than 3 months, and injection of a suspension of anticancer drugs.
Sakamoto
Ichiro
I
Department of Radiology, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
Iwanaga
Soji
S
Nagaoki
Kenji
K
Matsuoka
Yojiro
Y
Ashizawa
Kazuto
K
Uetani
Masataka
M
Fukuda
Toshio
T
Okimoto
Tomoaki
T
Okudaira
Sadayuki
S
Omagari
Katsuhisa
K
Hayashi
Kuniaki
K
Matsunaga
Naofumi
N
D000368:Aged; D001646:Bile; D001649:Bile Duct Diseases / Q000453:epidemiology / Q000209:etiology*; D001653:Bile Ducts, Intrahepatic; D006528:Carcinoma, Hepatocellular / Q000628:therapy*; D015984:Causality; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D007459:Iodized Oil / Q000008:administration & dosage; D008113:Liver Neoplasms / Q000556:secondary / Q000628:therapy*; D008297:Male; D011379:Prognosis; D012307:Risk Factors
D007459:Iodized Oil