Liver abscess occurring after TACE using new-type Gelfoam particles as embolic agent for primary hepatic cancer: report of three cases with literature review

Objective: To discuss the incidence of liver abscess that occurs after transcatheter arterial chemoembolization (TACE) by using new-type gelatin sponge particles (GSPs) as embolic agent for the treatment of primary hepatic cancer (PHC). Methods: During the period from June 2009 to August 2012, TACE by using new-type GSPs as embolic agent was performed in 208 PHC patients at authors' institute. The occurrence of liver abscess after TACE was recorded. The causes and mechanisms of the postoperative liver abscess were analyzed, and the experience concerning its prevention and treatment was summarized. Results: A total of 792 times of TACE procedure were accomplished in 208 patients with an average of 3.8 times for each patient. The mean interval between two TACE procedures was 4.9 months. The follow-up time ranged from 2 to 34 months with a mean of 13 months. Postoperative liver abscess occurred in three patients, the incidence of liver abscess was 0.38%(3/792). Of the three patients, percutaneous transhepatic external drainage of the abscess was carried out in one, and the patient continued to live for 25 months. No external drainage or abscess aspiration was adopted in the other two patients, and the two patients died in perioperative period. Conclusion: For the treatment of primary hepatic cancer, TACE by using new-type GSPs as embolic agent carries lower incidence of postoperative liver abscess. Active preventive measures should be taken in high risk patients. Earlier diagnosis and elective drainage can reduce the mortality rate. (authors)