Wan YX, Lin ZY, Chen LT, Wu RQ, Zhang Y, Du ZQ. Arterial and biliary complications after transarterial chemoembolization for hepatocellular carcinoma. World J Clin Oncol 2026; 17(1): 113618 [DOI: 10.5306/wjco.v17.i1.113618]
Corresponding Author of This Article
Zhao-Qing Du, MD, PhD, Professor, Researcher, Department of Hepatobiliary Surgery, Shaanxi Provincial People’s Hospital, No. 256 West Youyi Road, Xi’an 710068, Shaanxi Province, China. duzhaoqing2007@126.com
Research Domain of This Article
Oncology
Article-Type of This Article
Minireviews
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Jan 24, 2026 (publication date) through Jan 28, 2026
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Publication Name
World Journal of Clinical Oncology
ISSN
2218-4333
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Wan YX, Lin ZY, Chen LT, Wu RQ, Zhang Y, Du ZQ. Arterial and biliary complications after transarterial chemoembolization for hepatocellular carcinoma. World J Clin Oncol 2026; 17(1): 113618 [DOI: 10.5306/wjco.v17.i1.113618]
Yan-Xin Wan, Zhen-Yi Lin, Lin-Tao Chen, Yu Zhang, Zhao-Qing Du, Department of Hepatobiliary Surgery, Shaanxi Provincial People’s Hospital, Xi’an 710068, Shaanxi Province, China
Zhen-Yi Lin, National University of Singapore, Singapore 117597, Singapore
Rong-Qian Wu, National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
Zhao-Qing Du, National Engineering Research Center for Miniaturized Detection Systems, College of Life Science, Northwest University of Xi’an, Xi’an 710069, Shaanxi Province, China
Author contributions: Wan YX and Du ZQ contributed to conceptualization, data curation, writing - original draft; Lin ZY, Chen LT, Wu RQ, Zhang Y, and Du ZQ contributed to writing-review and editing; Du ZQ contributed to funding acquisition. All authors have read and approved the final manuscript.
Supported by the National Natural Science Foundation of China, No. 82200686.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zhao-Qing Du, MD, PhD, Professor, Researcher, Department of Hepatobiliary Surgery, Shaanxi Provincial People’s Hospital, No. 256 West Youyi Road, Xi’an 710068, Shaanxi Province, China. duzhaoqing2007@126.com
Received: August 29, 2025 Revised: September 24, 2025 Accepted: December 3, 2025 Published online: January 24, 2026 Processing time: 144 Days and 0.9 Hours
Abstract
Transarterial chemoembolization is a common treatment modality that significantly improves prognosis in patients with intermediate-advanced hepatocellular carcinoma. However, this procedure is associated with a spectrum of potential arterial and biliary complications, ranging from mild self-limiting ones to those severely affecting patient outcomes. This review systematically integrates recent studies to explore the epidemiological characteristics, risk factors, and management strategies of these two groups of complications. Arterial complications, primarily hepatic artery stenosis, pseudoaneurysm, and arterial rupture hemorrhage, exhibit a biphasic distribution pattern with the majority occurring within 72 hours postoperatively, while a notable portion occurs within 1-4 weeks. Biliary complications, including biliary fistulas, biliary strictures, and ischemic cholangitis, exhibit higher incidence rates and more insidious clinical manifestations than arterial complications. Risk factors include the severity of cirrhosis, tumor location, procedural technique, and chemotherapeutic drug toxicity. Management strategies emphasize careful preoperative planning (primarily with computed tomography angiography), standardized intraoperative procedures (like superselective embolization), and multi-pronged postoperative monitoring (imaging combined with laboratory indicators of liver function). Interventional embolization or surgical reconstruction is used for arterial complications, while endoscopic therapy or surgical drainage is selected based on the severity of injury for biliary complications. Future research should further explore individualized treatment regimens and novel embolic materials to reduce complication rates and enhance the safety of transarterial chemoembolization.
Core Tip: Transarterial chemoembolization for intermediate-advanced hepatocellular carcinoma carries arterial (stenosis, pseudoaneurysms, hemorrhage) and biliary (fistulas, strictures, cholangitis) complications, with biliary ones more prevalent (hilar tumors/cirrhosis as risk factors). Management involves preoperative imaging, intraoperative superselectivity, and postoperative surveillance, with targeted interventions for each complication type. This review synthesizes recent data to provide a holistic, updated framework for understanding and managing these issues.
