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.
Highlights
Hepatocellular carcinoma (HCC) is one of the most common cancers and is associated with a poor prognosis.[1]
It is difficult to predict the occurrence of HCC rupture and, there are a limited number of treatment options, which include conservative treatment, surgical hemostasis, transarterial embolization (TAE), and emergency or staged liver resection
Of the 132 patients, 45 (34.1%) patients received only conservative treatment according to their poor liver function and/or multiple tumor lesion or the wishes of the families, and surgical hemostasis was performed for 8 (13.6%) patients which didn’t maintain hemodynamic stability after conservative management with fluid and blood replacement 24
Summary
Hepatocellular carcinoma (HCC) is one of the most common cancers and is associated with a poor prognosis.[1] It develops in cirrhosis secondary to viral hepatitis or in patients with a history of alcohol abuse.[2] The incidence of HCC is increasing worldwide with an increasing prevalence of hepatitis C virus infection.[3,4,5,6] Spontaneous rupture with intraperitoneal hemorrhage is a fatal complication of HCC, having an incidence of 3%– 14.5%, which is higher in Asian countries than in western countries.[7,8,9,10,11] the incidence of ruptured HCC is decreasing because of earlier detection and advanced treatment, the mortality rate within 30 days of HCC rupture remains high at 31%–67%.1,10,12-16. It is difficult to predict the occurrence of HCC rupture and, there are a limited number of treatment options, which include conservative treatment, surgical hemostasis, transarterial embolization (TAE), and emergency or staged liver resection. We evaluate and compare the outcomes of various treatment methods for ruptured HCC employed at our hospital
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