LIVER-ABSCESS FORMATION AFTER LOCAL TREATMENT OF LIVER-TUMORS

Our goal was to determine a subset of patients at high risk of develop ing liver abscesses after local treatment of liver tumors (LTLT) and e stablish guidelines for the conduct of LTLT in the safest conditions i n such patients. Five hundred sixty-one LTLT, 489 transhepatic arteria l chemoembolizations (TAG), 10 hepatic embolizations, and 62 percutane ous intratumor injections (PIT), were retrospectively reviewed for liv er parenchyma necrosis and abscess formation, Four patients developed abscesses, three after TAC and one after PIT. Despite broad-spectrum a ntibiotherapy, percutaneous drainage, and surgery, two patients died. A left hepatectomy was required in the other two patients for cure. Al l four patients had a carcinoid or a neuroendocrine pancreatic tumor, Three out of four patients had bilioenteric anastomoses, and the fourt h had recently undergone cholecystectomy and papillotomy. A Lipiodol/d oxorubicin mixture without any particulate embolization was injected i n the three patients who developed abscesses after TAG. LTLT in patien ts with bilio enteric anastomosis or papillotomy and/or neuroendocrine or carcinoid tumor should be performed with strict precautions during the procedure and for peri-procedural care.