Liver abscess following transarterial chemoembolization for the treatment of hepatocellular carcinoma: A retrospective analysis of 23 cases
Zhongzhi Jia1, Jianfei Tu2, Chuanwu Cao3, Weiping Wang4, Weizhong Zhou5, Jiansong Ji2, Maoquan Li3
1 Department of Interventional Radiology, No. 2 People's Hospital of Changzhou, Nanjing Medical University, Changzhou 213003; Department of Interventional Radiology, People's 10th Hospital Affiliated to Nanjing Medical University, Shanghai 200072, China
2 Department of Radiology and Interventional Radiology, Lishui Central Hospital, Lishui, China
3 Department of Interventional Radiology, People's 10th Hospital Affiliated to Nanjing Medical University, Shanghai 200072, China
4 Department of Radiology, Mayo Clinic, Jacksonville, Florida 32224, USA
5 Department of Interventional Radiology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
Department of Interventional Radiology, People's 10th Hospital Affiliated to Nanjing Medical University, Shanghai 200072
Source of Support: None, Conflict of Interest: None
Objective: To investigate the incidence, management, and outcome of a liver abscess after transarterial embolization/chemoembolization (TAE/TACE) therapy for hepatocellular carcinoma (HCC).
Materials and Methods: From May 2007 to May 2014, all patients complicated with liver abscess following TAE/TACE for HCC were identified and analyzed at four medical centers.
Results: During the study period, a total of 6984 TAE/TACE procedures were performed among 3129 patients, and a total of 23 patients developed liver abscess with the incidence of 0.33% (23/6984) per procedure. There were 21 males and 2 females, and mean age of 52.1 ± 12.1 years. The mean interval from last TAE/TACE procedure to the diagnosis of liver abscess was 12.9 ± 6.6 days. All the patients received intravenous antibiotics, with ten patients had a percutaneous drain, one each for percutaneous aspiration and surgery. Complications related to the liver abscess were hepatorrhexis and pleural effusion (n = 1), pleural effusion (n = 1), and obstructive jaundice (n = 1), all of which were resolved after conservative treatments. The serum alpha-fetoprotein (AFP) levels were significantly reduced at 6 months after treatment (P < 0.01) in 15 patients whose AFP > 400 ng/mL preprocedure. Complete or partial tumor response at 6 months after TAE/TACE was achieved in three and twenty patients, respectively; and 6 months survival was 100%.
Conclusions: The incidence of a liver abscess after TAE/TACE is low; antibiotics therapy along was successful in about half patients, and percutaneous abscess aspiration/drainage were necessary in large size abscess and severely symptomatic patients; the outcomes are benign without worsening of the progression of underlying HCC.