Ruptured hepatocellular carcinoma as a complication of transarterial oily chemoembolization

Br J Surg. 1998 Apr;85(4):512-4. doi: 10.1046/j.1365-2168.1998.00664.x.


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.

MeSH terms

  • Carcinoma, Hepatocellular / therapy*
  • Chemoembolization, Therapeutic / adverse effects*
  • Chemoembolization, Therapeutic / methods
  • Cisplatin / administration & dosage*
  • Female
  • Humans
  • Liver Neoplasms / therapy*
  • Male
  • Middle Aged
  • Oils / adverse effects*
  • Retrospective Studies
  • Rupture, Spontaneous / etiology


  • Oils
  • Cisplatin