Role of emergency and staged hepatectomy in peritoneal metastasis associated with spontaneous rupture of resectable hepatocellular carcinoma patients

Abstract

Objective To evaluate the role of emergency and staged hepatectomy in peritoneal metastasis associated with ruptured hemorrhage of resectable hepatocellular carcinoma (HCC) patients, and investigate the impact of surgery timing-selecting on peritoneal metastasis of postoperative HCC patients. Methods A retrospective analysis was conduct on the pooled data from 38 HCC patients with spontaneously ruptured hemorrhage treated in our hospital from August 2011 to January 2016. These patients were divided into emergency group who underwent hepatectomy within 24 hours at admission, and staged group who underwent the procedure one week after admission. Perioperative events, overall survival (OS) and disease-free-survival (DFS) rates, incidence of recurrent and metastatic disease were compared between the two groups. Results The perioperative blood loss and transfusion were much more in emergency group than staged group (both P 0.05). The median survival was 22.5 months in emergency group versus 14.2 months in staged group. The 6-month, 1-year, 3-year OS rates in emergency group were 88.2%, 82.4% and 30.3% respectively, and 6-month, 1-year, 3-year DFS rates were 81.3%, 54.7% and 27.3%. The 1-year OS and 6-month DFS rates were higher than those of staged group (both P 0.05). Univariate and multivariate analysis indicated that tumor diameter ≥10 cm and AFP>10 000 μg/L were the risk factors for peritoneal metastasis after hepatectomy for HCC patients with spontaneously ruptured hemorrhage. Conclusions Emergency hepatectomy would warrant a better short-term prognosis compared with staged hepatectomy for the HCC patients with spontaneously ruptured hemorrhage. Staged hepatectomy would not raise the possibility of postoperative peritoneal metastasis. The predictors of tumor diameter ≥10 cm and AFP>10 000 μg/L were risk factors for peritoneal metastasis after hepatectomy for spontaneously ruptured HCC patients. Key words: Primary hepatocellular carcinoma; Spontaneous rupture; Hepatectomy; Peritoneal metastasis