Our goal was to determine a subset of patients at high Although rare, these complications are usually severe. risk of developing liver abscesses after local treatment Therefore, it is worthwhile to define the subset of paof liver tumors (LTLT) and establish guidelines for the tients with a high likelihood of developing such compliconduct of LTLT in the safest conditions in such pacations.
tients. Five hundred sixty-one LTLT, 489 transhepatic arterial chemoembolizations (TAC), 10 hepatic emboliza-PATIENTS AND METHODS tions, and 62 percutaneous intratumor injections (PIT), were retrospectively reviewed for liver parenchyma ne-
We reviewed the liver abscesses that occurred after thercrosis and abscess formation. Four patients developed apy during our last 5-year experience of 561 LTLT in 210 abscesses, three after TAC and one after PIT. Despite patients: 489 TAC, 10 hepatic artery embolizations, and 62 broad-spectrum antibiotherapy, percutaneous drainage, PIT. and surgery, two patients died. A left hepatectomy was TAC was performed in 181 patients, 44 of whom had carcirequired in the other two patients for cure. All four panoid tumor and 12 of whom had an islet cell carcinoma. We tients had a carcinoid or a neuroendocrine pancreatic performed 245 courses of TAC (1-7 courses/patient) for hepatumor. Three out of four patients had bilioenteric anastocellular carcinomas, 112 for metastases from carcinoid tutomoses, and the fourth had recently undergone cholemors, 20 for islet cell carcinoma metastases, and 112 for varicystectomy and papillotomy. A Lipiodol/doxorubicin ous hepatic tumors. Intra-arterial injections were performed mixture without any particulate embolization was inin the hepatic artery beyond the gastroduodenal artery or in jected in the three patients who developed abscesses the right and left branches of the hepatic artery. No superafter TAC. LTLT in patients with bilio enteric anastomoselective treatments were performed. Doxorubicin (50 mg/ sis or papillotomy and/or neuroendocrine or carcinoid m 2 ; Adriblastine; Lab Pharmacia, Saint Quentin, France) or tumor should be performed with strict precautions durcisplatin (1-2 mg/kg; Cisplatyl; Lab Rho ˆne Poulenc Rorer, ing the procedure and for peri-procedural care. (HEPA-Antony, France) were the most commonly used anticancer TOLOGY 1996;23:1436-1440.) drugs. They were always mixed with Lipiodol using the usual push-and-pull method with two syringes connected by a three-way stopcock. The amount of Lipiodol injected was °10
Local treatment of liver tumors (LTLT), such as mL in all cases. Embolization was performed after the mixed transhepatic arterial chemoembolization (TAC) and drug/lipiodol injection, nearly always using Gelfoam pledgets percutaneous intratumor injection (PIT), is frequently (1-3 mm; Spongel; Lab Houde, France), until complete occlu- used. In our experience, as shown in the literature, sion of the hepatic artery. Gelfoam powder was used only LTLT rarely induces severe complications, as long as when a coaxial catheter was required for catheterization of basic contraindications (portal vein thrombosis, extenappropriate branches for intra-arterial treatment. In the rare sive disease, impending hepatic failure, and biliary patients who presented intense slowing down of arterial flow, which persisted after injection of the drug/Lipiodol (Lab tract obstruction for TAC; ascites, altered hemostasis, Guerbet, Aulnay, France) mixture, no complementary emboand subcapsular lesions for PIT) are respected. 1 Necrolization was performed.
sis and abscess of the liver parenchyma are among the Hepatic artery embolizations, without injection of the more severe complications we encountered after LTLT.
drug/Lipiodol mixture, were performed 8 of 10 times in three patients with hormone-related disorders (hypoglycemia, carcinoid syndrome) and contraindications to anticancer drugs. These embolizations were mainly performed to control hor-Abbreviations: LTLT, local treatment of liver tumors; TAC, transhepatic arterial chemoembolizations; PIT, percutaneous intratumor injection; CT, com-mone disorders. Gelfoam pledgets were the only embolic maputed tomography. terial used.