Abstract No. 286: Biliary complications after transarterial chemoembolization for hepatocellular carcinoma

Abstract

Given the range of techniques and chemoembolic formulations currently in use, the prevalence and risk factors for biliary injury following transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) remain unclear. The purpose of this study is to determine the prevalence of biliary complications following three-drug and gelfoam TACE. Records of 122 consecutive patients (mean age 61 years; 96 men) who underwent TACE (1-8 treatments per patient) for HCC in 2008 were retrospectively reviewed. Segmental or subsegmental TACE using a mixture of doxorubicin 25 mg, cisplatin 50 mg and mitomycin C 10 mg with Ethiodol followed by gelfoam slurry was performed. All patients completed follow-up liver function tests and a contrast-enhanced CT of the abdomen four weeks after TACE. Biliary complications including intrahepatic biliary ductal dilation, biloma or biliary sepsis were encountered in 12 patients (10%). Four of the patients developed cholangitis which required hospital admission, and one presented with a liver abscess which was treated with intravenous antibiotics. The remaining seven (58%) were asymptomatic with new segmental or lobar intrahepatic biliary ductal dilation noted on routine followup CT. Patients with a biliary complication had undergone a higher number of TACE procedures (3.2 versus 2.3; p=0.05). Biliary complications after TACE may be more prevalent in current practice than previously described in the literature.