Transcatheter arterial chemoembolisation (TACE)

This is a palliative procedure offered to patients with liver cancer or liver metastatic colorectal carcinoma who are not eligible for surgery, but have adequate functional liver reserves for the potential benefits to outweigh procedure related risks. The concept of liver arterial precision therapy is the ability to point doses of chemotherapy directly to the liver tumor(s) while sparing the patient the many side effects of traditional chemotherapy that is given to the whole body.

TACE is a minimally invasive procedure performed in interventional radiology to restrict a tumor's blood supply. Small embolic particles coated with chemotherapeutic agents are injected selectively into an artery directly supplying a tumor.

The treatment requires up to 4 individual procedures which are usually within a week to two weeks of each other but this is very much on a case-by-case basis. Your interventional radiologist will discuss your specific treatment with you in detail.

How is a TACE procedure performed?

The procedure is conducted in an angiography suite at Intra, which is in the Mercy Hospital at 98 Mountain Road, Epsom in Auckland. Your interventional radiologist will be assisted by nurses and other highly trained staff.

  • The procedure is usually carried out using local sedation. It is very rare for a general anaesthetic.
  • A tiny plastic tube called a catheter, is introduced through a sheath via a small incision (less than 6mm) in the groin. You cannot feel the catheter moving inside your arteries. Your interventional radiologist watches the catheter on an x-ray screen as he directs the tip of catheter to the arteries leading to the tumour.
  • A small amount of “dye” (also called contrast) is injected through the catheter to confirm the catheter position.
  • The radiologist injects a special fluid containing the embolic particles down the catheter.
  • This causes the veins to close down, and consequently blocks the artery and blood supply to the tumor.
  • Additional x-ray images are taken to confirm the artery closure.
  • Following this, the catheter is removed.
  • Firm pressure is applied on the point of entry for 5-10 minutes, when the sheath is removed, to prevent any bleeding. Alternatively, a closure device may be used so that no pressure needs to be applied.

This treatment may require a few repeat procedures, however, this varies from individual to individual. Your interventional radiologist will discuss your specific treatment plan with you.

Would I be suitable for TACE?

TACE has been most widely delivered to liver cancer patients who are not eligible for surgery.  TACE therapy has shown to increase survival in patients with intermediate liver cancer. It has also been used as an alternative to surgery for resectable early stage liver cancer and in patients with regional recurrence of the tumor after previous resection. TACE may also be used to downstage liver cancer in patients who exceed the criteria for liver transplantation. A TACE procedure plays a palliative role in patients with metastatic colon carcinoma.

What will I experience during the procedure?

  • An intravenous catheter (IV line) for the administration of fluids and medication will be inserted into a vein on the back of your hand or in your arm.
  • You will feel a slight pin prick when the needle is inserted into your vein for the intravenous line (IV) and when the local anaesthetic is injected through the groin area to gain access to your femoral artery.
  • Devices to monitor your heart rate and blood pressure will be attached to your body.
  • You may also be given oxygen.
  • You will be given mild sedation and pain relief through your IV to make you feel relaxed.
  • You may feel slight pressure when the catheter is inserted, but no significant discomfort. You cannot feel the catheter moving through your body.
  • As the contrast material passes through your body, you may get a warm feeling.

Should your Interventional Radiologist feel that it is safer and more comfortable to use a general anaesthetic for your procedure, you will not be aware of anything during the procedure.
While you are in the hospital, your pain will be well-controlled with medications infused through your IV line.

How should I prepare for the procedure?

  • Fasting: You will likely be instructed not to eat or drink anything after midnight before your procedure. You may still drink clear fluids. Your doctor will tell you which medications you may take in the morning.
  • Medications: Please inform your doctor about all the medication you are taking. You doctor may advise you to stop taking some medications temporarily few days prior to your procedure e.g. blood thinners.
  • Allergies or previous reactions to contrast (x-ray dye): Please inform Intra staff at the time of booking your procedure if you have any known history of allergies, particularly allergies to x-ray contrast and seafood.
  • Diabetes: If you are a diabetic you should inform your doctor at the time of booking. You may need to discuss your insulin dose with your doctor.

Please bring with you any medication and any recent blood tests, ultrasound results or x-rays.

On the day of your procedure, please make your way to the Mercy Hospital Reception where they will be expecting you. You will be admitted to a Mercy Hospital ward and transferred to Intra for your procedure.

For directions to the Mercy Hospital, click here.

What happens after the procedure?

  • Your Interventional Radiologist will discuss the findings with you following the procedure or at a follow-up appointment.
  • You will be transferred to the hospital ward on a bed and will need to lie flat for at least an hour before the nurses will sit you up and mobilise you, depending on any oozing or bleeding at the puncture site in the groin.
  • The nurses in the ward will do routine examinations e.g. taking your pulse and blood pressure and also ensuring that the entry site is healing well.
  • You are advised to avoid doing any heavy lifting for at least five days to allow healing time for the puncture site.

What are the risks or complications?

  • As with any interventional procedure, there is a small risk of bleeding and/or damage to blood vessels.
  • Pseudo aneurysm can develop at the site of puncture in the femoral artery.
  • During this procedure contrast media is used, to which patients may develop an allergic reaction.
  • Off-target delivery of embolic agents into healthy surrounding tissue is a potential side effect that may cause complications such as ulceration of the gut or cholecystitis.
  • TACE induces tumor necrosis in more than 50% of patients; the resulting necrosis releases cytokines and other inflammatory mediators into the bloodstream.