Analisi retrospettiva della prevalenza di complicanze correlate alle procedure di chemioembolizzazione intra-arteriosa epatica (TACE) nelle differenti classi di rischio

Abstract

Transcatheter hepatic chemoembolization (TACE) is widely used in the treatment of unresectable hepatic tumors. Although considered relatively safe, TACE has been associated with several complications. The aim of this study was to determine the prevalence of complications and correlate them with some know risk factors. Between 2004 and 2009 we treated 155 patients (106 men and 49 women) with 297 sessions of TACE. 193 patients had primitive liver tumor and 104 had metastases from different primitivities. The patients were aged 49–86 years. TACE procedures were performed either with drug loaded microspheres (136 sessions with DCBead®; 124 with Hepasphere®) and with iodized oil (33 with Lipiodol®). The chemoterapeutic agent used was Epidoxorubicin in 217 sessions, Irinotecan in 30 and Oxaliplatin in 50. Our data showed that major complications occurred in 16.5% of patients. Specifically we found acute pancreatitis (2.7%), liver abscess (3%), cholecystistis (3.7%) and autoimmune thrombocytopenia (3.4%). Around 80 % of patients had postembolization syndrome that is not considered a complication but rather an expected outcome of embolotherapy. Complications occurred more frequently in diabetic than in non diabetic patients (26.7% vs 13.1%; p=0.006). Conversely we didn’t find any statistically significant differences according to the embolization agents used (Lipiodol® vs microspheres), the chemotherapic agent (Epidoxorubin vs Oxalplatin vs Irinotecan ), the age of the patients and the histology (primary vs metastatic tumors). All patients received antibiotic therapies before and after TACE; no statistically significant differences were found among the different classes of antibiotics used. Also no more complications were found with combined therapies (TACE+RFTA) than with TACE alone. Among the know risk factors only diabetes increases the prevalence of complications of TACE. TACE with Lipiodol® is more painful than drug loaded microspheres.