Immediate and delayed complications of transarterial chemoembolization with drug-saturable microspheres in unresectable liver tumors

Backgraund: For many years of world experience in the use of transarterial chemoembolization (TACE) on liver tumors, data have appeared on immediate and delayed complications, which, however, represent a description of clinical observations or literature reviews compiled on their basis. There are currently no systematic studies that study the timing of complications and risk factors.
Aims: to evaluate immediate and delayed complications of transarterial chemoembolization with drug-saturable microspheres in the treatment of unresectable malignant liver tumors.
Materials and methods: A retrospective observational uncontrolled study that included 75 patients with unresectable liver disease (65 patients with metastases, 10 patients with primary malignant tumors) who underwent 102 transarterial chemoembolizations with drug-saturable microspheres. The antitumor effect of TACE was assessed according to abdominal computed tomography (CT) and magnetic resonance imaging of the hepatobiliary zone (MRI) with intravenous contrast, performed within a limited time frame: no later than 2 weeks before (control 0), after 8–9 weeks (control 1) and 16–17 weeks after TACE (control 2). In the event of complications, diagnostic studies were performed as clinically necessary.
Results: 3 patients developed lesions of the biliary tree. The process began on days 2–11 after TACE with dilatation of the bile ducts in single segments; changes in 2–3 weeks took on a bilobar character, leading to the formation of bilomas (2 patients) and necrosis of the periductal liver parenchyma (1 patient). Before TACE, all three patients underwent bile duct stenting due to existing biliary hypertension. Two patients developed pancreatitis 1–2 weeks after TACE; at the same time, there were no features of vascular anatomy, non-target embolization. In 17 patients after 2-4 months after TACE according to CT and MRI, the phenomena of cholecystitis were noted. The changes were asymptomatic, leading to the formation of small stones in the gallbladder lumen after 6–10 months.
Conclusions: The immediate complications of TACE with drug-saturated microspheres (1-3%) in the treatment of unresectable liver tumors are associated with the pathology of the bile ducts and pancreas, appear in the first month, have a staging, affect the somatic condition of patients and require specific treatment. Long-term complications (23%) are associated with the reaction of the gallbladder, develop after a few months, while they are asymptomatic and do not require correction.