Empiric antibiotics for transarterial embolization in hepatocellular carcinoma: indicated?
BACKGROUND
Transarterial embolization (TAE) remains a common treatment option in unresectable patients with hepatocellular cancer (HCC); however there are no standard protocols for post procedure care in these patients who often have extensive disease, marginal liver function, and multiple comorbidities. The aim of this study was to examine antibiotics use in HCC undergoing TAE.


METHODS
A prospective review of our center's 1109 hepato-pancreatico-biliary patients, from 1/99 to 7/07, was performed to identify all HCC patients.


RESULTS
Two hundred one patients with HCC, of whom 59 (29.4%) underwent bland, TAE, or Yttrium-90 therapy. All embolizations were performed by experienced interventional radiologists and were admitted to the surgical oncology service for post-procedure care. There were 46 men and 13 women, with a median age of 61 y. The mean MELD score was 10.9 (8.5-17) with 25 of 59 having <25% liver involvement. The lesion size ranged from 2 to 12 cm with a mean of 4.88 cm; 24 patients (41%) received a single pre-procedural dose of an antibiotic, 7 (12%) a dose of an antibiotic pre- and post-procedurally, and 28 (47%) did not receive any form of antibiotic. The mean length of stay was 1 (0-5) d depending on adjuvant procedures performed during the same hospital admission. No immediate or long term infectious complications were noted, including liver abscess, cholangitis, pneumonia, or sepsis with a median follow up of 28 mo.


CONCLUSIONS
The current practice of pre- or post-procedure antibiotics is variable and no evidence can support giving or not giving antibiotics for hepatic arterial therapy. The uses are not indicated as prophylaxis against hepatic infectious complications in patients undergoing transarterial embolization for the treatment of hepatocellular cancer.
Shelgikar
Chinmaya S
CS
Division of Surgical Oncology, Department of Surgery and James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, Kentucky 40202, USA.
Loehle
Jennifer
J
Scoggins
Charles R
CR
McMasters
Kelly M
KM
Martin
Robert C G
RC
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000628:therapy*; D002761:Cholangitis / Q000382:microbiology / Q000517:prevention & control; D002945:Cisplatin / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D004317:Doxorubicin / Q000627:therapeutic use; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D008100:Liver Abscess / Q000382:microbiology / Q000517:prevention & control; D008113:Liver Neoplasms / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000627:therapeutic use; D015999:Multivariate Analysis; D011014:Pneumonia / Q000382:microbiology / Q000517:prevention & control; D011183:Postoperative Complications / Q000382:microbiology / Q000517:prevention & control*; D011446:Prospective Studies; D012189:Retrospective Studies; D018805:Sepsis / Q000382:microbiology / Q000517:prevention & control
D000900:Anti-Bacterial Agents; D016685:Mitomycin; D004317:Doxorubicin; D002945:Cisplatin