Emergency Transcatheter Arterial Embolization in Ruptured Hepatocellular Carcinoma in Siriraj Hospital

Abstract

Objective: To review the outcome of the patients who had ruptured hepatocellular carcinoma after receiving TAE and to identify prognostic indicators in Siriraj Hospital

Patient and Method: Retrospectively reviewed the outcome of patients who had undergone TAE for rupture of HCC during March 2003 - December 2006,. Angiographic finding, arterial embolization, size of tumor, tumor location. agents used for embolization were recorded. The final outcome in terms of technical success, 0-3 day clinical success. 30 days mortality rate. overall mean survival time and complication were recorded. Correlation between portal vein patency with incidence of liver failure was calculated. We also compared their survival time in each child-Pugh classification and with respect to different prognostic indicators.

Results: Adult: 35 men and 3 women. (ranges 17-89 years and mean age 53.11 years. At the time of ruptured tumor) 2 patients had Child’s A, 13 Child’s B and 23 of Child’s C disease. The most common presentation was abdominal pain (17 patients). Bleeding was successfully immediate arrested in all 38 patients. The most tumor location was detected at right lobe of liver (20 patients). The overall mean survival was 61.92 days. We found that survival time between Child B and C classification had statistically significant difference. Twenty four patients died within 30 days after TAE. the major cause of death was liver failure. which occurred in 7 patients. In addition, we had also postulated several prognostic indicators for patients’ survival. The results showed that only those with a bilirubin level more than 3 mg/dl had a poor outcome. (P=0.05)

Conclusion: TAE should be considered in management of patients with ruptured HCC. It is effective in arresting tumor bleeding. Patients who are considered poor surgical candidates with Child B or C hepatic cirrhosis might have emergency embolization as a life-saving measure. Failure TAE is not depends on only technique but also depends on underlying disease and general condition prior embolization.