Abstracts
1997 Digestive Disease Week

Ruptured hepatocellular carcinoma as a complication of transarterial oily chemoembolization.

CL Liu*, ST Fan*, CM Lo, H Ngan§. Departments of *Surgery and §Diagnostic Radiology, The University of Hong Kong, Queen Mary Hospital, Hong Kong.

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 have not been reported previously. From January 1989 to October 1996, 391 patients received totally 1443 sessions of TOCE (mean = 3.7 sessions) either as the primary treatment for unresectable HCC (333 patients) or as treatment for postresectional recurrence or residual tumor (58 patients). During the study period, six patients developed ruptured HCC one day to two weeks after TOCE resulting in overall incidence of 1.5% per patient and 0.42% per procedure. The mechanism of rupture is postulated to be related to tumor necrosis and increase in pressure inside friable tumor after TOCE. All except one patient died (range 1 to 25 days from rupture) resulting in mortality rate of 83%. There were common factors to these six patients who had ruptured HCC after TOCE: (1) All were male patients. (2) All had large HCC (range: 8 to 17 cm in diameter). (3) The main tumor was situated at the right lobe of liver. (4) All had their tumor ruptured after the first session of TOCE. (5) All of them did not receive previous hepatectomy and TOCE was performed as the primary treatment for unresectable HCC. In summary, ruptured HCC is a serious complication of TOCE although the incidence is low. It predominantly occurs in male patients who received their first session of TOCE for unresectable large right lobe HCC.