Ruptured Hepatic Carcinoma After Transcatheter Arterial Chemoembolization☆

BACKGROUND Transcatheter arterial chemoembolization (TACE) is recommended as the first-line therapy for unresectable hepatic carcinoma (HCC). Serious complications such as hepatic abscess and hepatic decompensation are well known, but rupture of HCC after TACE is a rare complication. OBJECTIVE The aim of this study was to identify the associated risk factors and the outcomes resulting from ruptured HCC after TACE. METHODS A retrospective analysis was performed in 6 patients who experienced ruptured HCC after TACE. RESULTS All patients underwent chemoembolization after superselective catheterization of the appropriate hepatic artery. The interval between the treatment of TACE and ruptured HCC was 6 to 17 days (mean [SD] 10.33 [4.08] days). Common features in ruptured HCC were large tumor size, location of the tumor adjacent to liver capsular membrane, and complete occlusion of the tumor feeding artery, especially in those with a large amount of iodized oil plus polyvinyl alcohol particles. Two patients underwent emergency embolization, and 4 patients received conservative treatment. Except for 2 patients treated conservatively who died 45 and 68 days after ruptured HCC with hepatic decompensation, the other 4 patients survived to the 6-month follow-up. CONCLUSIONS Ruptured HCC after TACE is a rare but serious complication. Large tumor size, location of the tumor adjacent to the liver capsule, and complete occlusion of the feeding artery may be predisposing factors. More research is needed to examine which patients presenting with ruptured HCC after TACE would benefit from conservative or emergency arterial embolization procedures.