Determinants of postembolization syndrome after hepatic chemoembolization

PURPOSE: Postembolization syndrome (PES) occurs in the majority of patients undergoing hepatic chemoembolization, and is the major reason for hospital ization after the procedure. The ability to identify which groups of patien ts are at increased or decreased risk of PES would be useful to better coun sel patients, to minimize toxicity, and to plan inpatient versus outpatient therapy. MATERIALS AND METHODS: Seventy hepatic chemoembolization procedures were pe rformed in 29 patients using cytotoxic drugs mixed with Ethiodol and polyvi nyl alcohol. The following procedural variables were retrospectively assess ed and evaluated for association with PES and length of postprocedural hosp italization: gallbladder embolization, lobe embolized, percentage liver vol ume embolized, percentage embolized volume occupied by tumor, previous embo lization of the same territory, and dose of chemoembolic emulsion. Logistic regression was used to quantify the relative effect of each procedural var iable. RESULTS: Gallbladder embolization and dose administered were associated wit h an increased risk of PES and an extended hospitalization, with odds ratio s of 2.8 and 3.0, and 3.0 and 4.6, respectively. Previous embolization was associated with a decreased risk of both PES and extended hospitalization, with odds ratios of 0.5 and 0.4, respectively. There was a statistical tren d toward significance for gallbladder embolization (P = .06), dose administ ered (P = .07), and previous embolization (P = .14). CONCLUSION: Clinically relevant predictors of the severity of PES and lengt h of postprocedural hospitalization may exist. Avoiding embolization of the gallbladder reduces the risk of PES. Re-embolization of previously treated vessels is associated with decreased toxicity and may assist in selecting patients for treatment on an outpatient basis, especially when a reduced do se is required.