HCC : Acute Obstructive Cholangitis Complicated by Tumoral Migration after Transarterial Chemoembolization; A Case Report and Literature Review

( Hyung Chul Park ),( Hyun Bum Park ),( Cho Yun Chung ),( Min Woo Jung ),( Young Eun Joo ),( Sung Kyu Choi ),( Sung Bum Cho ) 대한간학회 2013 춘·추계 학술대회 (KASL) Vol.2013 No.1

Background: The intraductal tumor invasion of hepatocellular carcinoma is considered to be rare. Transarterial chemoembolization is also effective for tumor thrombus of hepatocellular carcinoma in the bile duct. Recently, a few cases have reported the incidence of obstructive jaundice caused by migration of tumoral fragment after transarterial chemoembolization. However, it is usually difficult to predict of the tumoral migration after transarterial chemoembolization, because of the low incidence rate, ignorant of this disease, and the difficulty for the imaging diagnosis to find the intrabiliary tumor fragment. Case: At this writing, a review of the medical literature disclosed 7 reported cases of biliary obstruction caused by the migration of necrotic tumor cast after transarterial chemoembolization. We, herein, report an additional case of acute obstructive cholangitis complicated by migration of necrotic tumor cast after transarterial chemoembolization for intrabile duct invasion of hepatocellular carcinoma, in a 71-year-old man. The tumor cast in common bile duct was successfully removed by using basket during endoscopic retrograde cholangiography and was pathologically confirmed to completely necrotic fragment of hepatocellular carcinoma. The symptoms of the patient were dramatically improved. Conclusions: In summary, physicians caring for the patients treated by transarterial chemoembolization should be aware acute obstructive cholangitis complicated by tumoral migration. We suggest that an intrabile duct invasion would be major predisposing factor of tumoral migration after transarterial chemoembolization and drainage procedures such as endoscopic retrograde cholangiography or percutaneous transbiliary drainage are effective treatment modalities in these patients.

Radiofrequency Ablation for Liver Metastases after Transarterial Chemoembolization: A Systemic Analysis

Xu, Chuan,Lv, Peng-Hua,Huang, Xin-En,Wang, Shu-Xiang,Sun, Ling,Wang, Fu-An Asian Pacific Journal of Cancer Prevention 2015 Asian Pacific journal of cancer prevention Vol.16 No.12

Background: This systemic analysis was conducted to evaluate tumor recurrence rate and one-year survival rate for patients with liver metastases received radiofrequency ablation after transarterial chemoembolization and introduce a new method of radiofrequency ablation by puncture navigation technology for single liver metastases after transarterial chemoembolization. Materials and Methods: Clinical studies evaluating tumor recurrence rate and one-year survival rate. Appling the innova trackvision software to process one liver metastases received transarterial chemoembolization and using radiofrequency ablation by puncture navigation technology to treat the liver metastases. Results: 3 clinical studies which including 235 patients with liver metastases after transaeterial chemoembolization were considered eligible for inclusion. Systemic analysis suggested that tumor recurrence rate was 23% (54/235), one-year survival rate was 76% (178/235). The new procedure was performed successfully and the patient received a good prognosis. Conclusions: This systemic analysis suggests that radiofrequency ablation is a good method for liver metastases after transarterial chemoembolization and could receive a relatively good prognosis.

간세포암의 간동맥 화학색전술후 Lipiodol에 의한 폐 장애

이종균,정훈용,한철주,이준혁,이한주,이효석,김정룡 대한내과학회 1992 대한내과학회지 Vol.42 No.1

간세포암의 간동맥 화학색전술후 분명한 동-정맥 단락의 증거없이 발생한 Lipiodol에 의한 폐 장애 2예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Symptomatic pulmonary embolism by Lipiodol (iodized ethyl esters of the fatty acids of poppy-seed oil) after transarterial chemoembolization for hepatocellular carcinoma has not been reported in the literature. We experienced 2 cases of symptomatic pulmonary complication after transarterial chemoembolization using Lipiodol, adriamycin, gelfoam, and mitomycin-C for the treatment of a huge hepatocellular carcinoma which did not show any angiographic evidence of arteriovenous shut. The first patient suffered from cough, hemoptysis, and fever on the 5th day after transarterial chemoembolization. The presence of retained Lipiodol in the lung was proven by CT scan. The second patient suffered from dyspnea, cough, hemoptysis, and fever on the 4th day after transarterial chemoembolization. The delayed onset of respiratory symptoms was probably due to pulmonary edema compliating pulmonary embolism by Lipiodol.

간동맥 화학색전술 후 풍선형 지혈기구의 유용성

김승기(Kim Seung-Gi) 대한방사선과학회(구 대한방사선기술학회) 2019 방사선기술과학 Vol.42 No.3

Transarterial chemoembolization is one of the most representative procedures for puncture of the femoral artery. In addition, the same procedure is often repeatedly performed many times, and Hepatocellular carcinoma patients due to cancer is significantly lowered blood tests, regardless of platelet counts are not good enough to stop bleeding. More importantly, hepatocellular carcinoma has a high degree of complication and disease severity, which makes it less likely that the condition of the body will be relatively inferior to other patients. In order to prevent delayed hemorrhage of the femoral artery puncture site after the procedure, it is advised to absolutely stabilize the limb so that it does not bend the limb for 3 hours after climbing in the ward. Therefore, I have been complaining about inconvenience. In addition, in order to prevent delayed hemorrhage after hemostasis, balloon type hemostatic device was used instead of sand bag which was placed on hemostatic site. The results of this study were compared with the results of actual application. The use of a balloon-type hemostatic device to increase the effectiveness of continuous hemostasis and to minimize the inconvenience during the time of patient s absolute bed rest, rather than raising the sandbag to prevent primary delayed hemorrhage by various methods in transarterial chemoembolization. It can be used as a substitute for existing sand bags because it can alleviate pain, increase satisfaction, and can be used as a disposable one.

Original Articles : The usefulness of contrast-enhanced ultrasonography in the early detection of hepatocellular carcinoma viability after transarterial chemoembolization: pilot study

( Youn Zoo Cho ),( So Yeon Park ),( Eun Hee Choi ),( Soon Koo Baik ),( Sang Ok Kwon ),( Young Ju Kim ),( Seung Hwan Cha ),( Moon Young Kim ) 대한간학회 2015 Clinical and Molecular Hepatology(대한간학회지) Vol.21 No.2

Background/Aims: The therapeutic effect of transarterial chemoembolization (TACE) against hepatocellular carcinoma (HCC) is usually assessed using multidetector computed tomography (MDCT). However, dense lipiodol depositions can mask the enhancement of viable HCC tissue in MDCT. Contrast-enhanced ultrasonography (CEUS) could be effective in detecting small areas of viability and patency in vessels. We investigated whether arterial enhancement in CEUS after treatment with TACE can be used to detect HCC viability earlier than when using MDCT. Methods: Twelve patients received CEUS, MDCT, and gadoxetic-acid-enhanced dynamic magnetic resonance imaging (MRI) at baseline and 4 and 12 weeks after TACE. The definition of viable HCC was defined as MRI positivity after 4 or 12 weeks. Results: Eight of the 12 patients showed MRI positivity at 4 or 12 weeks. All patients with positive CEUS findings at 4 weeks (n=8) showed MRI positivity and residual viable HCC at 4 or 12 weeks. Five of the eight patients with positive CEUS findings at 4 weeks had negative results on the 4-week MDCT scan. Four (50%) of these eight patients did not have MRI positivity at 4 weeks and were ultimately confirmed as having residual HCC tissue at the 12-week MRI. Kappa statistics revealed nearperfect agreement between CEUS and MRI (κ=1.00) and substantial agreement between MDCT and MRI (κ=0.67). Conclusions: In the assessment of the response to TACE, CEUS at 4 weeks showed excellent results for detecting residual viable HCC, which suggests that CEUS can be used as an early additive diagnosis tool when deciding early additional treatment with TACE. (Clin Mol Hepatol 2015;21:165-174)

Incidence and Risk Factors of Acute Ischemic Cholecystitis after Transarterial Chemoembolization: Correlation with Cone Beam CT Findings

Jong Yeong Kim,Jung Suk Oh,Ho Jong Chun,Su Ho Kim 대한영상의학회 2024 대한영상의학회지 Vol.85 No.2

Purpose Acute cholecystitis is a complication of transarterial chemoembolization (TACE) that occasionally requires surgical intervention. We aimed to analyze the incidence and risk factors of cholecystitis requiring surgical intervention in patients with embolic material uptake on cone beam CT (CBCT) performed immediately after various TACE procedures. Materials and Methods After a retrospective review of 2633 TACE procedures performed over a 6-year period, 120 patients with embolic material retention in the gallbladder wall on CBCT immediately after TACE were selected. We analyzed the incidence of and risk factors for acute cholecystitis. Results The overall incidence of acute cholecystitis requiring surgical intervention was 0.45% (12 of 2633 TACE procedures); however, it was present in 10% (12 of 120) of procedures that showed high-density embolic material retention in the gallbladder wall on CBCT performed immediately after TACE. Acute cholecystitis requiring surgical intervention occurred in eight patients (66.7%) who underwent direct cystic arterial embolization. Surgical intervention was performed 15 days (mean) after TACE. Conclusion Most unintended chemolipiodol deposits in the gallbladder wall resolved without intervention or surgery. However, superselective direct cystic arterial chemoembolization was associated with a high incidence of acute cholecystitis requiring surgery, and patients who undergo this procedure should be closely monitored.

The usefulness of contrast-enhanced ultrasonography in the early detection of hepatocellular carcinoma viability after transarterial chemoembolization: pilot study

조윤주,김문영,최은희,백순구,권상옥,김영주,차승환,박소연 대한간학회 2015 Clinical and Molecular Hepatology(대한간학회지) Vol.21 No.2

Background/Aims: The therapeutic effect of transarterial chemoembolization (TACE) against hepatocellular carcinoma (HCC) is usually assessed using multidetector computed tomography (MDCT). However, dense lipiodol depositions can mask the enhancement of viable HCC tissue in MDCT. Contrast-enhanced ultrasonography (CEUS) could be effective in detecting small areas of viability and patency in vessels. We investigated whether arterial enhancement in CEUS after treatment with TACE can be used to detect HCC viability earlier than when using MDCT. Methods: Twelve patients received CEUS, MDCT, and gadoxetic-acid-enhanced dynamic magnetic resonance imaging (MRI) at baseline and 4 and 12 weeks after TACE. The definition of viable HCC was defined as MRI positivity after 4 or 12 weeks. Results: Eight of the 12 patients showed MRI positivity at 4 or 12 weeks. All patients with positive CEUS findings at 4 weeks (n=8) showed MRI positivity and residual viable HCC at 4 or 12 weeks. Five of the eight patients with positive CEUS findings at 4 weeks had negative results on the 4-week MDCT scan. Four (50%) of these eight patients did not have MRI positivity at 4 weeks and were ultimately confirmed as having residual HCC tissue at the 12-week MRI. Kappa statistics revealed near-perfect agreement between CEUS and MRI (κ=1.00) and substantial agreement between MDCT and MRI (κ=0.67). Conclusions: In the assessment of the response to TACE, CEUS at 4 weeks showed excellent results for detecting residual viable HCC, which suggests that CEUS can be used as an early additive diagnosis tool when deciding early additional treatment with TACE. (Clin Mol Hepatol 2015;21:165-174)

Outcome of transarterial chemoembolization-based multi-modal treatment in patients with unresectable hepatocellular carcinoma.

Song, Do Seon,Nam, Soon Woo,Bae, Si Hyun,Kim, Jin Dong,Jang, Jeong Won,Song, Myeong Jun,Lee, Sung Won,Kim, Hee Yeon,Lee, Young Joon,Chun, Ho Jong,You, Young Kyoung,Choi, Jong Young,Yoon, Seung Kew WJG Press 2015 WORLD JOURNAL OF GASTROENTEROLOGY Vol.21 No.8

<P>To investigate the efficacy and safety of transarterial chemoembolization (TACE)-based multimodal treatment in patients with large hepatocellular carcinoma (HCC).</P>

Child-Pugh B군인 간세포암 환자에서 sorafenib과 경동맥화학색전술 병합 치료

이종식 ( Jong Sik Lee ),문선영 ( Sun Young Moon ),이경언 ( Kyung Ann Lee ),민재기 ( Jae Ki Min ),전성진 ( Sung Jin Jeon ),김인애 ( In Ae Kim ),이강훈 ( Kang Hoon Lee,),최원혁 ( Won Hyeok Choe ),김정한 ( Jeong Han Kim ),권소영 ( So 대한간암학회 2014 대한간암학회지 Vol.14 No.1

combined with transarterial chemoembolization (TACE) in Child-Pugh (CP) class-B patients with hepatocellular carcinoma (HCC). Methods: A total of 12 CP class-B patients who were initially treated with sorafenib combined with TACE were retrospectively reviewed. At 14 days after the first TACE, patients were continuously treated with sorafenib until unacceptable adverse events (AEs) or diseaseprogression. Consecutive TACEs were also performed, if patients were tolerable. Results: Of 12 patients, 8, 3 and 1 patients had CP-score 7, 8, and 9, respectively. The median overall survival was 85 days. Patients underwent median 2 sessions of TACE (range 1-4) and the median duration of sorafenib was 48days (range, 12-92 days). Three patients refused repeated TACEs and 4 patients required delay of the consecutive TACE due to AEs of sorafenib. Six patients required transient or permanent discontinuation of sorafenib, due to its AEs (grade 1/2 AEs, 2 patients; grade 3/4 AEs, 4 patients). High CP score (score 8/9 vs. 7) was tended to be association with interruption of sorafenib (P=0.061) and requirement of refusal/ delay of consecutive TACE (P=0.081). Conclusions: Sorafenib combined with TACE were frequently interrupted or delayed in CP class-B patients, mostly because of its side effects, even though there were not serious. Our experiences suggest that combination with sorafenib and TACE might interface with each other due to its side effects in CP class-B patients, especially patients with CP score 8/9 liver cirrhosis.

간암 환자에서 간동맥 색전술후 예후 및 예후인자

김성수(Sung Soo Kim),이창돈(Chang Don Lee),최상욱(Sang wook Choi),한남익(Nam Ik Han),김진일(Jin Il Kim),한상원(Sang Won Hang),윤승규(Seung Kew Yoon),양진모(Jin Mo Yang),박영민(Young Min Park),한석원(Sun Won Han),이영석(Young Suk Lee) 대한소화기학회 1998 대한소화기학회지 Vol.30 No.1

N/A Background/Aims: The transarterial chemoembolization(TACE) has been applied for nonsurgical treatment for hepatocellular carcinoma(HCC) and is widely used in the management of resectable and unresectable HCC in many countries. The aim of this study was to introduce our experience about the survival period and significant prognostic factors associated with TACE in patients with unresected HCC. Methods: The cumulative survival period of 102 patients with HCC was determined by Kaplan-Meiers method. Parameters likely to influence the prognosis were subjected to univariate analysis using log-rank test, and parameters which were significant in the univariate analysis were subjected to rnultivariate analysis using Coxs proportional hazard model. Results: The mean survival period after TACE was 12.79 months, and the overall cumulative survival rates were 58.76% for 6 months, 36.12% for 1 year, 18.06% for 2 year, and 4.90% for 3 years. According to univariate analysis, parameters significantly associated with the survival were portal vein thrombosis, frequency of TACE, TNM stage, serum alkaline phosphatase and total bilirubin. Multivariate analysis revealed that portal vein thrombosis and the frequency of TACE were statistically significant. Conclusions: These findings suggest that portal vein thrombosis is significant and independent prognostic factor, and that repetition of TACE is an effective measure for prolonging surviva1 time in patients with HCC. (Korean J Gastoenterol 1997; 30:72-80)