Safety and efficacy of transarterial embolization of hepatocellular adenomas

Abstract

Background Hepatocellular adenoma (HCA) larger than 5 cm in diameter has an increased risk of haemorrhage and malignant transformation, and is considered an indication for resection. As an alternative to resection, transarterial embolization (TAE) may play a role in prevention of complications of HCA, but its safety and efficacy are largely unknown. The aim of this study was to assess outcomes and postembolization effects of selective TAE in the management of HCA. Methods This retrospective, multicentre cohort study included patients aged at least 18 years, diagnosed with HCA and treated with TAE. Patient characteristics, 30‐day complications, tumour size before and after TAE, symptoms before and after TAE, and need for secondary interventions were analysed. Results Overall, 59 patients with a median age of 33.5 years were included from six centres; 57 of the 59 patients were women. Median tumour size at time of TAE was 76 mm. Six of 59 patients (10 per cent) had a major complication (cyst formation or sepsis), which could be resolved with minimal therapy, but prolonged hospital stay. Thirty‐four patients (58 per cent) were symptomatic at presentation. There were no significant differences in symptoms before TAE and symptoms evaluated in the short term (within 3 months) after TAE (P = 0·134). First follow‐up imaging was performed a median of 5·5 months after TAE and showed a reduction in size to a median of 48 mm (P < 0·001). Conclusion TAE is safe, can lead to adequate size reduction of HCA and, offers an alternative to resection in selected patients.

Unclassified hepatic hepatocellular adenoma in men still a diagnosis by exclusion: Case report and review of the literature.

“…Hence, surgery remained an effective treatment in such complications as in our patient [18]. For non-complicated hepatocellular adenoma smaller than 5 cm, trans arterial embolization may constitute a mini-invasive alternative to surgery especially for young patients with cosmetic outcomes [19].…”

Behavior and complications of hepatocellular adenoma during pregnancy and puerperium: a retrospective study and systematic review

“…Previous series have demonstrated effectiveness and safety for TAE and RFA in HCA patients. 62,63 Several risk factors for symptomatic HCA bleeding, have been identified including diameter 5 cm, exophytic growth, hemorrhage observed on imaging, presence of central or peripheral arteries on imaging, sonic hedgehog subtype, and hepatic parenchymal steatosis >30%. 6,64 Especially H-HCA are less likely to bleed.…”

Base molecular de los adenomas hepatocelulares y su implicación médico-quirúrgica

“…(37) Otros métodos de tratamiento investigados aplicados a los AHC son la embolización transarterial (TAE por sus siglas en inglés) y la ablación tumoral ya sea ablación con radiofrecuencia o ablación con microondas. (38) A pesar de que el TAE es un tratamiento bien establecido para el AHC se ha visto que puede provocar hemorragia aguda con inestabilidad hemodinámica. Estudios recientes también han investigado su seguridad y eficacia en el JUDITH PÉREZ ROJAS, MANUEL DURÁN PÓVEDA.…”

“…La ablación tumoral también puede usarse en el tratamiento de AHC, pero a menudo se requieren múltiples sesiones y los pacientes pueden tener adenoma residual a pesar del tratamiento repetido. (38) Tanto la TAE como las técnicas de ablación tumoral, pueden ser beneficiosas sólo en pacientes con pequeñas lesiones.…”