Safety and efficacy of transarterial embolization of hepatocellular adenomas. Issue 10 (17th July 2019)

• Record Type: Journal Article
• Authors: van Rosmalen, B V; Klompenhouwer, A J; de Graeff, J Jaap; Haring, M P D; de Meijer, V E; Rifai, L; Dokmak, S; Rawashdeh, A; Abu Hilal, M; de Jong, M C; Dejong, C H C; Doukas, M; de Man, R A; IJzermans, J N M; van Delden, O M; Verheij, J; van Gulik, T M
• Is Part Of: British journal of surgery. Volume 106:Issue 10(2019)
• Page Start: 1362
• Page End: 1371
• Publication Date: 2019-07-17
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1002/bjs.11213
• Languages: English
• ISSNs: 0007-1323

Abstract

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. Graphical Abstract: Transarterial embolization (TAE) is relatively safe and can lead to adequate size reduction of hepatocellular adenoma. This minimally invasive intervention offers an interesting alternative to resection. Alternative treatment for large adenomas