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      Treatment of spontaneous ruptured hepatocellular carcinoma: A single-center study

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          Abstract

          Objectives: Spontaneous rupture of hepatocarcinoma (HCC) is a fatal complication of advanced HCC and is associated with poor prognosis. However, there is no consensus on the best approach to treat hemoperitoneum due to ruptured HCC. In this paper, we evaluate and discuss the outcomes of different treatment methods employed at our center for ruptured HCC.

          Methods: We reviewed the medical records of 132 patients diagnosed with ruptured HCC at our hospital from January 2003 to December 2012 and evaluated and compared the outcomes of five treatment methods for ruptured HCC: conservative treatment, surgical hemostasis, transarterial embolization (TAE), and one- and two-stage resections.

          Results: There was no significant difference in the median survival time between the conservative treatment and surgical hemostasis groups. Patients in the TAE alone group had a better prognosis than those in the conservative treatment and surgical hemostasis groups. The survival time of the tumor resection group was obviously better than that of the conservative treatment, surgical hemostasis, and TAE alone groups, but no significant difference was observed between the one-stage and two-stage resection groups.

          Conclusions: One-stage hepatectomy is a better option for patients with preserved liver function, whereas TAE is a better option for those with poorly preserved liver function.

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          Primary liver cancer in Japan. Clinicopathologic features and results of surgical treatment.

          (1990)
          The Liver Cancer Study Group of Japan analyzed statistically 12,887 cases of primary liver cancer diagnosed from January 1, 1982 to December 31, 1985 in more than 500 institutes throughout the country. The study was based on the answers to 258 questions. There were 4354 cases of hepatocellular carcinoma, 256 cases of cholangiocellular carcinoma, 49 cases of mixed carcinoma, 22 cases of hepatoblastoma, 10 cases of sarcoma, and 74 other cases. The survey and analysis, based mainly on 4765 histologically proved cases, included gross anatomic and histologic features of the tumors, pathology of the noncancerous portion, distant metastases, past medical history, frequency of positive Hepatitis B surface antigen and Hepatitis B surface antibody, age distribution, various diagnostic procedures, surgical procedures, and survival rate in relation to operative curability and tumor stage.
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            Management of spontaneous rupture of hepatocellular carcinoma: single-center experience.

            Annette Tso, Frank Fan, Margaret Lam … (2001)
            To report the management of patients with spontaneous rupture of hepatocellular carcinoma (HCC) in a single center over a 10-year period and to evaluate a two-stage therapeutic approach. A retrospective study was performed on all 1,716 patients with HCC who presented from 1989 to 1998. The two-stage therapeutic approach to manage ruptured HCC consisted of initial management by conservative method, hemostasis by transarterial embolization (TAE) or surgical means, followed by second-stage hepatic resection or transarterial oily chemoembolization (TOCE). Results of definitive treatment were compared with patients with no history of rupture during the same study period. During the study period, 154 patients (9%) had spontaneous HCC rupture. Initial intervention to control bleeding included TAE in 42 patients, surgical hemostasis in 35 patients, and conservative management only in 53 patients. The 30-day mortality rate was 38%. Independent factors on presentation affecting 30-day mortality were shock on admission, hemoglobin, serum total bilirubin, and known diagnosis of inoperable tumor. After initial stabilization and clinical evaluation, 33 patients underwent hepatic resection and 30 patients received TOCE. Median survival of the hepatectomy patients was 25.7 months; that of the TOCE patients was 9.7 months. Compared with patients with no rupture, survival after hepatectomy (25.7 months v 49.2 months, P =.003) was inferior but still substantially long, whereas survival after TOCE was comparable (9.7 months v 8.7 months, P =.904). Early mortality of spontaneous rupture of HCC was dependent on prerupture disease state, liver function, and severity of bleeding. Although it was a catastrophic presentation, prolonged survival could be achieved in selected patients with second-stage hepatic resection or TOCE.
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              Spontaneous rupture of hepatocelluar carcinoma: surgical resection and long-term survival.

              R Polastri, Marcela A. Ferrero, L Capussotti … (2000)
              Spontaneous rupture of hepatocellular carcinoma (HCC) is a life-threatening event, particularly in patients with associated cirrhosis. We present our experience of hepatic resection of ruptured HCC. We performed 199 resections of hepatocellular carcinoma between January 1984 and December 1999. Six (3%) of these patients were operated on as an emergency because of haemoperitoneum: in five the liver was cirrhotic. The mean duration of the operation was 195+/-101 min; all the patients received blood transfusions. The overall morbidity was 50%, with a mortality rate of 16.5%. Three patients were alive at 50, 80 and 116 months respectively; two had an intrahepatic recurrence treated by chemoembolization. Non-surgical treatment of spontaneously ruptured hepatocarcinoma should be performed only in patients with contraindication to surgery. Hepatic resection should be the treatment of choice since, according to our experience, long-term results are similar to those of elective surgery. Copyright 2000 Harcourt Publishers Ltd.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Pak J Med Sci
                Journal ID (iso-abbrev): Pak J Med Sci
                Journal ID (publisher-id): PJMS
                Title: Pakistan Journal of Medical Sciences
                Publisher: Professional Medical Publicaitons (Karachi, Pakistan )
                ISSN (Print): 1682-024X
                ISSN (Electronic): 1681-715X
                Publication date (Print): May-Jun 2014
                Volume: 30
                Issue: 3
                Pages: 472-476
                Affiliations
                [1 ]Hanteng Yang, Department of Liver Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.
                [2 ]Kefei Chen, Department of Liver Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.
                [3 ]Yongang Wei, Department of Liver Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.
                [4 ]Fei Liu, Department of Liver Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.
                [5 ]Hongyu Li, Department of Liver Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.
                [6 ]Zhipeng Zhou, Department of Liver Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.
                [7 ]Bo Li, Department of Liver Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.
                Author notes
                Correspondence: Bo Li, MD, PhD, Department of Liver Surgery, West China Hospital, Sichuan University, Chengdu 610041, China. E-mail: Boli2011@163.com huaxilibo@126.com
                Article
                DOI: 10.12669/pjms.303.4001
                PMC ID: 4048488
                PubMed ID: 24948961
                SO-VID: 30924719-b7da-4743-826a-b2e54797b650
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, ( http://creativecommons.org/licenses/by/3.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 23 June 2013
                Date revision received : 27 February 2014
                Date accepted : 2 March 2014
                Categories
                Subject: Original Article

                Keywords: hepatocellular carcinoma,ruptured,treatment
                Data availability:
                Keywords: hepatocellular carcinoma, ruptured, treatment

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