Ruptured hepatocellular carcinoma as a complication of transarterial oily chemoembolization

Background Transarterial oily chemoembolization (TOCE) is frequently employed as a non‐operative treatment for hepatocellular carcinoma (HCC). Serious complications of TOCE are well known but ruptured HCC as a fatal complication of TOCE has not been reported previously. Methods A retrospective study was performed on all patients who received TOCE for treatment of HCC from January 1989 to October 1996; the complication of ruptured HCC within 2 weeks from the procedure was recorded. Results During the study period, 391 patients received a total of 1443 sessions of TOCE (mean 3·7 sessions per patient) for the treatment of HCC, with an overall median survival of 10·4 months. Six patients developed ruptured tumour within 2 weeks after TOCE, resulting in an overall incidence of 1·5 per cent per patient or 0·4 per cent per procedure. All except one patient died 1–25 days after tumour rupture. Factors common to these six patients included: (1) male sex; (2) large tumour size (range 8–17 cm in diameter); (3) tumour located in the right lobe of the liver; (4) tumour ruptured after the first session of TOCE; and (5) TOCE performed as primary treatment without previous hepatic resection. Conclusion Ruptured HCC is a serious complication of TOCE although the incidence is low. It occurred predominantly in men after the first session of TOCE for a large irresectable tumour of the right lobe. © 1998 British Journal of Surgery Society Ltd