This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS
Cytolysis following chemoembolization for hepatocellular carcinoma. BJS 1999; 86: 176-180.
Published: 2nd January 2003
Authors: F. Paye, O. Farges, M. Dahmane, V. Vilgrain, J. F. Flejou, J. Belghiti et al.
Background
Lipiodolized chemoembolization of hepatocellular carcinoma (HCC) can induce fever and cytolysis, defined as an increase in serum levels of liver transaminases, which is frequently assumed to result from tumour necrosis. This study aimed to assess the causes of this syndrome, reviewing preoperative data, intraoperative findings, tumour necrosis and the status of non‐tumorous liver.
Method
A retrospective study was undertaken of 29 patients treated by neoadjuvant lipiodolized chemoembolization before surgical resection of HCC. Tumour necrosis was assessed in the resected specimen and scored in four stages: absent, 50 per cent or less, more than 50 per cent, and complete. The status of non‐tumorous liver parenchyma was classified as either fibrotic or cirrhotic.
Results
Cytolysis occurred following chemoembolization in 16 patients and was associated with fever in 11. Postchemoembolization cytolysis with or without fever was more likely to develop in patients with minor fibrotic changes than in those with cirrhosis (14 of 21 with fibrosis versus two of four with cirrhosis, P < 0·05). In contrast, the extent of tumour necrosis did not correlate with the occurrence of symptoms.
Conclusion
These results suggest that fever and cytolysis following chemoembolization of HCC are an indication not of tumour necrosis but of injury to the non‐tumorous liver. © 1999 British Journal of Surgery Society Ltd
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