Major Complications after Conventional Chemoembolization for Hepatocellular Carcinoma in the Era of C-Arm Computed Tomography

Objectives: To evaluate the prevalence and contents of major complications after conventional trans arterial cehmoembolization (cTACE) for hepatocellular carcinoma (HCC) in the era of cone-beam computed tomography (CBCT) depending on tumor stages. Methods: We retrospectively reviewed electronic medical records of 822 patients who underwent cTACE for HCC between 2010 and 2011. Among them, 556 patients underwent cTACE under the guidance of CBCT. The prevalence and contents of major complications after initial cTACE were collected and the influence of tumor stage was investigated. Results: Major complications developed in 39 (4.7%) of 822 patients. Their prevalence in BCLC 0, A, B, and C stages was 0% (0/160), 2.9% (8/274), 1.2% (2/164), and 12.9% (29/224), respectively. In BCLC A stage, major complications developed in 8 patients (4 liver abscess, 1 septicemia with infarction, 1 gallbladder perforation, 1 variceal bleeding, and 1 spontaneous bacterial peritonitis). Four patients had predisposing factors of bilioenteric anastomosis (n = 2), previous history of variceal bleeding (n = 1), and emergent TACE for ruptured HCC (n = 1). In BCLC B stage, major complications developed in two patients (1 liver abscess and 1 septicemia in a patient with biliary invasion). In BCLC C stage, major complications developed in 29 patients (deterioration of liver function, hepatic encephalopathy, liver abscess, septicemia, biliary injury, disabling pleural effusion, variceal bleeding, spontaneous bacterial peritonitis, and acute kidney injury as alone or in various combinations) with 1-month mortality in one patient. The prevalence of major complication in BCLC C stage was largely affected by the extent of portal vein thrombosis (segmental:sectional:lobar:bilateral or main = 0.0%:5.0%:11.8%:25.0%). Conclusion: cTACE for HCC can be safely performed in the early and intermediate stage or in advanced HCC with limited portal tumor thrombosis.

Publication History

Article published online:
26 April 2021