Intrahepatic cholangiocarcinoma (ICC) is the second most common primary liver cancer, which has a poor prognosis. In the last few decades, the incidence of ICC and subsequent ICC-related mortality has gradually increased worldwide [1]. Since ICC is asymptomatic in the early stage, most patients with ICC have vascular invasion or metastatic disease when diagnosed, which makes them unsuitable for surgical resection or liver transplantation. Therefore, loco-regional treatments have been proposed to improve survival among patients with unresectable ICC.

Drug-eluting bead transarterial chemoembolization (DEB-TACE) is a safe and effective treatment strategy for unresectable ICC [2], [3], [4]. DEB-TACE has some advantages relative to conventional transarterial chemoembolization (c-TACE), and it has been gradually adopted by physicians. The slow and sustained release of antineoplastic drugs increases the concentration of drugs in the tumor and reduces systemic toxicity. In addition, the uniform shape and diverse size of the embolism beads can increase embolization efficacy.

Unfortunately, this treatment modality can cause serious complications, including liver abscess and biloma formation [5]. Uninterrupted drainage and long-term control of infection prolong hospital stays, elevate medical costs, and increase mortality. Unlike primary liver abscess, mortality from TACE-associated liver abscess has been reported to be as high as 50 % [6]. Meanwhile, biloma formation significantly deteriorates the prognosis of liver abscess. Therefore, these risks should be carefully considered when performing DEB-TACE for patients with unresectable ICC.

Reports indicate that DEB-TACE is accompanied by a high rate of tumor necrosis [7]. Experience with c-TACE is difficult to directly guide the practice of DEB-TACE to reduce the incidence of liver abscess and biloma formation. Therefore, it needs to be clarified which factors may contribute to liver abscess and biloma formation after DEB-TACE in unresectable ICC patients. However, risk factors of liver abscess and biloma formation after DEB-TACE for unresectable ICC have not been well studied previously. The purpose of the current study was to investigate the frequency and risk factors of liver abscess and biloma formation in unresectable ICC patients who had undergone DEB-TACE procedure.