Hepatogastric fistula formation after liver chemoembolization in a patient with hepatocellular carcinoma

Abstract

Hepatocellular carcinoma (HCC) accounts for 75% to 95% of all cases of primary liver cancer. The number of cases of newly diagnosed hepatocellular cancer (HCC) in the Russian Federation in 2019 accounted to 9324. Currently, the method of transarterial chemoembolization (TACE) is widely used for the treatment of patients with malignant liver tumors. Various methods of transarterial embolization of the liver are used, including selective or superselective catheterization and the use of various chemotherapeutic and embolizing agents. In recent years, calibrated synthetic microspheres loaded with a chemotherapeutic agent have been developed. They ensure uniform and prolonged release of the drug and the achievement of high concentrations of the chemotherapeutic agent in tumor cells. The method of transarterial embolization of the liver using grains containing the drug is known as DEB‑TACE (Drug‑eluting bead transarterial chemoembolization).  The traditional TACE (conventional transarterial chemoembolization), technique is also widely used, in which a chemotherapeutic drug is administered together with lipiodol, and then with occlusive material. When comparing the techniques, no differences were found in their safety profiles. Despite the fact that transarterial embolization of the liver is considered a safe procedure, it is not without the risk of complications, the most common of which are acute cholecystitis and leukopenia. Also, a frequent undesirable phenomenon after transarterial chemoembolization of the liver is postembolization syndrome, which includes abdominal pain, hyperthermia up to 38 °  C and nausea. One of the rare complications occurring in less than 1% of cases is a complication of liver TACE – the development of a liver abscess against the background of tumor necrosis. It is believed that the formation of an abscess can lead to the formation of fistulas: hepaticobronchial, hepaticoduodenal, hepaticogastric, etc. Our article presents a rare clinical case of hepatogastric fistula formation after liver TACE.