Systematic review of transarterial embolization in the management of hepatocellular adenomas

Abstract

Background: Hepatocellular adenoma (HCA) is an indication for resection, if there is a risk of haemorrhage and malignant transformation. Transarterial embolization (TAE) is used to manage bleeding HCA and occasionally to reduce tumour size. TAE may have potential as elective therapy, but its current role in this context is uncertain. This systematic review provides an overview of clinical outcomes after TAE, in bleeding and non-bleeding HCA. Addittionally, 3 treated patients from our own center will be discussed in detail. Methods: A systematic search in PubMed and Embase was performed. Outcomes were change in tumour size, avoidance of surgery, complications and malignant transformation after TAE. The CASP tool for cohort studies was used for quality assessment. Results: From the 320 retrieved records, 20 cohort studies and 20 case reports including 851 patients met the inclusion criteria. TAE was performed in 151 of 851 (18%) patients, with 196 embolized HCA, of which 96 (49%) were non-bleeding. Surgical treatment was avoided in 73 of 151 (48%) patients. Elective TAE was performed in 49 patients with 66 HCA; (84%) of these patients did not require further surgical management. Major complications occurred in 8 of 151 patients (5%) and no mortality was reported. Among cohort studies, complete tumour disappearance was observed in 9% of patients, and regression in 76%. Conclusion: Acute or elective TAE in the management of HCA can be considered safe. In the elective setting, TAE provides a potential alternative to surgery.