J Korean Radiol Soc.  2000 Aug;43(2):171-177. 10.3348/jkrs.2000.43.2.171.

Intraperitoneal Hemorrhage Due to Spontaneous Rupture of Hepatocellular Carcinoma: Comparisons of Tranarterial Oily Chemoembolization and Simple Embolization with Gelfoam

• Lee JM
• Han YM
• Ym YS
• Ym SH
• Kweon KS

• KMID: 2200669
• DOI: http://doi.org/10.3348/jkrs.2000.43.2.171

Abstract

PURPOSE: To compare the safety and effectiveness of transarterial oily chemoembolization (TOCE) and transar-terial embolization (TAE) with Gelfoam in cases of ruptured hepatocellular carcinoma (HCC), and to describe the most important prognostic factors involved in emergency embolization.
MATERIALS AND METHODS
Forty-two consecutive patients with spontaneously ruptured HCC underwent emergency TOCE (n = 22) or TGE (n = 20). In the TOCE group, Lipiodol (3 -10 cc), Adriamycin (20 -50 mg), and Mitomycin (2 -10 mg) were used, and these were followed by blockade of the hepatic arterial flow with gelatin sponge particles. In the TAE group, patients underwent only Gelfoam embolization. Using the Kaplan-Meier method, survival time from the time of embolization was estimated, and to analyze prognostic factors, Cox 's proportional hazard regression model was used.
RESULTS
Successful hemostasis was achieved in 41 patients (97.6%). Mean survival time was 201 and 246 days in the TOCE and TAE group, respectively, but the difference was not tatistically significant (p > 0.05). Five of the TOCE group (22.7%) and three of the TAE group (15.0%) died of hepatic failure. Analysis of the prognostic factors showed that portal vein involvement by the tumor was the most important factor influencing survival.
CONCLUSION
Although TOCE and TAE effectively controlled hemorrhaging from a ruptured HCC, the procedures involve a high risk of hepatic failure. Their goal should, therefore, be solely to achieve hemostasis, and thus decrease parenchymal injury.

Keyword

Liver neoplasms, angiography; Hepatic arteries, therapeutic blockade

MeSH Terms

Carcinoma, Hepatocellular*
Doxorubicin
Emergencies
Ethiodized Oil
Gelatin
Gelatin Sponge, Absorbable*
Hemorrhage*
Hemostasis
Humans
Liver Failure
Mitomycin
Porifera
Portal Vein
Rupture, Spontaneous*
Survival Rate
Doxorubicin
Ethiodized Oil
Gelatin
Mitomycin