Abstract
BackgroundThe aim of our study was to evaluate the clinical safety and value of ethanol surgical field infiltration (ESFI), combined with distilled water peritoneal lavage (DWPL), after hepatectomy in patients with hepatocellular carcinoma (HCC) rupture.MethodsRat liver tissue samples were soaked in dehydrated ethanol for different soaking times, and 18 rats were assigned to three groups that underwent different soaking methods of the hepatectomy cut surface. We retrospectively reviewed 45 patients who underwent hepatectomy for treatment of ruptured HCC. Among these, EFSI combined with DWPL was used in 21 patients (DAW group), with only DWPL used in the other 24 patients (DW group). Clinical outcomes were compared between the two groups.ResultsFor in vitro experiments, the depth of coagulation degeneration and necrosis increased with the duration of soaking. For in vivo experiments, rats in all three groups survived until postoperative day 7 without significant postoperative complication. In patients, the rate of post-operation complication was comparable between the two groups (P = 0.398), with no between-group differences in liver function levels. The incidence of peritoneal dissemination was significantly higher for DW than DAW group (P = 0.037). Kaplan–Meier test identified dehydrated ethanol treatment as a significant factor of disease-free survival (DFS) (P = 0.036). On univariate analysis, dehydrated ethanol treatment was associated with better prognostic outcomes, although it was not retained as an independent factor of patient outcome.ConclusionsDehydrated ethanol soaking of the cut surface of the hepatectomy could potentially lower the risk of metastasis and improve the effect of hepatectomy for ruptured HCC as well as showed potential therapeutic value for intraoperative iatrogenic rupture of HCC.
Highlights
The aim of our study was to evaluate the clinical safety and value of ethanol surgical field infiltration (ESFI), combined with distilled water peritoneal lavage (DWPL), after hepatectomy in patients with hepatocellular carcinoma (HCC) rupture
Some studies argue that it is an overestimation to assign a T4 classification to all resectable ruptured tumors, others have demonstrated that spontaneous HCC rupture carries a specific additional negative impact on overall survival (OS) and disease-free survival (DFS) and, that a 0.5 to 2 stage classification should be added to the baseline tumor stage [6, 7]
In vitro experiment On histological examination, hepatocytes shriveled after soaking in the dehydrated ethanol
Summary
The aim of our study was to evaluate the clinical safety and value of ethanol surgical field infiltration (ESFI), combined with distilled water peritoneal lavage (DWPL), after hepatectomy in patients with hepatocellular carcinoma (HCC) rupture. Curative liver resection is the most effective treatment for ruptured HCC to improve patient survival This treatment is associated with a high rate of tumor recurrence due to the risk of implanted metastases [6, 8]. Several methods have been developed in an attempt to decrease the incidence of metastases, including peritoneal lavage with distilled water (DWPL). This conventional technique has been widely used to remove bacteria and tumor cells from the abdominal cavity. The cytocidal activity of the DWPL technique is decreased by contamination of the water once it is in contact with the peritoneal cavity, as well as by the limited time window available for lavage to be successful [9, 10]
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