Abstract
Surgical resection of spontaneously ruptured hepatocellular carcinoma (HCC) after successful transarterial embolization (TAE) remains controversial. The aim of this study was to investigate its efficacy in a series of cases. We retrospectively examined ruptured HCC cases from Jan 2000 to Dec 2008; all of these 126 cases received TAE as the initial therapy. Subsequently, 74 cases received staged surgical resection, and the remaining 52 cases underwent repeated TACE. The baseline demographic data, tumor characteristics, and long term survival were recorded and compared. The demographic and baseline characteristics were comparable between the hepatic resection and TACE groups; furthermore, no significant difference in the tumor characteristics was detected between the two groups. The differences in in-hospital, 30- day and 90-day mortality between the two groups were not significant (P>0.05). However, the 1-, 3-, and 5-year overall survival rates were 85.1%, 63.5%, and 37.8%, respectively, in the hepatic resection group, which were significantly higher than those in the TACE group (69.2%, 46.2%, and 17.3%, respectively, P=0.004). Univariate and multivariate analyses indicated that these patients benefitted from hepatic resection compared with TACE with respect to long-term outcomes. Staged hepatic resection after TAE is an effective treatment that results in superior long-term survival to repeated TACE.
Highlights
Hepatocellular carcinoma (HCC) is the fifth leading cause of cancer worldwide and is the second leading cause of cancer-related death; most of the hepatocellular carcinoma (HCC) disease burden is found in Asia and Africa due to hepatitis B (HBV) or C (HCV) infection (Jemal et al, 2011)
Baseline characteristics Based on the inclusion and exclusion criteria, 126 cases were included in the present study, and transarterial embolization (TAE) for hemostasis was successful in all cases
Various alternative hypotheses have been formulated to explain the precise mechanism that leads to HCC rupture: subcapsular location, dimensions, portal hypertension, tumor necrosis, and locally increased venous pressure due to the reduction of outflow caused by neoplastic invasion (Castells et al, 2001)
Summary
Hepatocellular carcinoma (HCC) is the fifth leading cause of cancer worldwide and is the second leading cause of cancer-related death; most of the HCC disease burden is found in Asia and Africa due to hepatitis B (HBV) or C (HCV) infection (Jemal et al, 2011). Due to the large tumor volume and impaired liver function inherent in HCC rupture, TAE has recently been reported provide a survival benefit (Kirikoshi et al, 2009; Jin et al, 2013). Some groups have argued that TACE should be the first treatment for these patients due to their advanced stage, poor overall prognosis, large tumor volume, impaired liver function, and implantation metastasis (Li et al, 2009; Toshikuni et al, 2011; Shin et al, 2011). We compared the long-term outcomes of ruptured HCC cases that underwent hepatic resection or TACE after successful TAE as the initial therapy for hemostasis.
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