Postmortem survey of bile duct necrosis and biloma in hepatocellular carcinoma after transcatheter arterial chemoembolization therapy: relevance to microvascular damages of peribiliary capillary plexus.

The present study was aimed at determining the incidence of bile duct necrosis and biloma in hepatocellular carcinoma (HCC) after transcatheter arterial embolization therapy (TAE) or hepatic arterial infusion chemotherapy (HAI), and also clarifying the relationship between these duct injuries and the peribiliary capillary plexus (PBP). These bile duct injuries were found in seven (12.5%) of the 56 consecutive autopsy livers with HCC and a history of TAE or HAI, whereas they were not in the 48 consecutive autopsy livers with HCC but without such a history (p < 0.02). There was a close relation between the areas of TAE and bile duct injuries. These complications were restricted to the intrahepatic large or septal bile ducts. The inner layer vessels of PBP were considerably reduced in the HCC cases with a history of TAE or HAI, irrespective of these bile duct injuries. We concluded that bile duct necrosis or biloma was not uncommon in cirrhotic livers with HCC after TAE or HAI, and that TAE or HAI might cause the reduction of the inner layer vessels of PBP which may be necessary but was insufficient for the induction of bile duct necrosis or biloma.