title: Ruptured hepatocellular carcinoma following chemoembolization: a western experience.
abstract: BACKGROUND
  Transcatheter arterial chemoembolization (TACE) is a recommended first line therapy for unresectable hepatocellular carcinoma (HCC). Serious complications such as neutropenic sepsis and hepatic decompensation are well known, but rupture of HCC following TACE is a rare and potentially fatal complication. The aim of this study was to identify the incidence of ruptured HCC following TACE and the associated risk factors.
  
  
  METHODS
  A retrospective analysis was performed using our liver database with key words "chemoembolization", "ruptured HCC" covering the patients who received chemoembolization from January 1995 to December 2005. There were no exclusions.
  
  
  RESULTS
  A total of 294 patients received chemoembolization in 530 sessions during the 10-year period. Of these, 2 ruptured following treatment (incidence 0.68%). The mean age was 65 years and the interval between the treatment and rupture was 2 and 24 days. The common factors were male sex, large tumor size (range 11-13 cm), and exophytic tumor growth. One patient died 2 days after rupture with hepatic decompensation while the second is alive after a 6-month follow up without tumor recurrence.
  
  
  CONCLUSIONS
  Ruptured HCC following TACE is a rare but serious complication. Large tumor size, male sex, and exophytic growth of tumor may be predisposing factors for rupture.
authors.affiliation: Institute of Liver Studies, King's College Hospital, Denmark Hill, London, SE5 9RS, UK.
authors.forename: Narendra
authors.initials: N
authors.lastname: Battula
authors.forename: Parthi
authors.initials: P
authors.lastname: Srinivasan
authors.forename: Mansoor
authors.initials: M
authors.lastname: Madanur
authors.forename: Srinivas Prabhu
authors.initials: SP
authors.lastname: Chava
authors.forename: Oliver
authors.initials: O
authors.lastname: Priest
authors.forename: Mohamed
authors.initials: M
authors.lastname: Rela
authors.forename: Nigel
authors.initials: N
authors.lastname: Heaton
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects*; D006801:Humans; D008113:Liver Neoplasms / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012422:Rupture, Spontaneous / Q000209:etiology