Outcomes of Surgical Resection for Ruptured Hepatocellular Carcinoma

BACKGROUND/AIMS: Many recent studies have shown excellent outcomes of surgical resection for ruptured hepatocellular carcinoma (HCC). In addition, there are several reports suggesting that a ruptured HCC did not increase the risk for peritoneal dissemination of a tumor after surgical resection. However, the impact of HCC rupture on recurrence and patient survival has not yet been clarified. METHODS: The medical data of patients who underwent surgical resection for ruptured HCC in our center between January 2011 and December 2015 were retrospectively reviewed. The outcomes of the patients were investigated. RESULTS: Among 128 patients who underwent surgical resection for HCC, 5 patients (3.9%) had a ruptured HCC. All patients underwent elective operation in a stable condition. Transarterial chemoembolization (TACE) was performed for achieving hemostasis in four patients except one who achieved spontaneous hemostasis. Two patients had tumor recurrence and one patient died due to HCC recurrence during the median follow-up duration of 28.3 months (range, 24.3–62.3 months). One patient who developed late intrahepatic recurrence at 40.0 months after resection was managed well by means of radiofrequency ablation and TACE and is now alive for 5 years without any evidence of viable tumor. However, the other patient who showed early peritoneal seeding at 1.9 months after resection finally died despite aggressive treatments. CONCLUSIONS: Rupture of HCC might result in peritoneal seeding of the tumor in the early postoperative stage, which could lead to a poor result. Nonetheless, surgical resection may be the best treatment option yielding good survival, even for a ruptured HCC.

Findings of ruptured hepatocellular carcinoma on computed tomography in Thailand

Background: A spontaneously ruptured hepatocellular carcinoma (HCC) carries an extremely poor prognosis and high mortality. In Thailand, the reported incidence of ruptured HCC was 12.4 % . Objective: To evaluate the computed tomography (CT) findings of ruptured HCC at King Chulalongkorn Memorial Hospital, Thailand. Methods: We reviewed the CT findings of 15 patients who were diagnosed as having a ruptured HCC and underwent CT scan of the upper abdomen. Two experienced radiologists analyzed the CT findings regarding the tumor’s size, tumor’s number, location, hepatic segment involvement, contour protrusion including appearance of the mass and ascites. Results: The study population consisted of 15 men with mean age of 57.4 years (27-78 years). All cases showed liver cirrhosis. All ruptured tumors were located at the periphery of the liver and had a protruding contour. The maximum diameter of the tumors ranged from 2.8-17.2 cm (mean 7.44 cm). Marginal disruption was seen in 9 cases (60 %). Five cases (33 %) presented with hematoma and high attenuation around the ruptured mass. All cases of ruptured HCC had ascites. Conclusion: The peripheral location, protruding contour, marginal disruption of the tumor with the background of a cirrhotic liver are highly suggestive of ruptured HCC.

Repeat Resection for Intrahepatic and Omental Recurrence of Ruptured Hepatocelluar Carcinoma after the Initial Surgery

The most serious problem of ruptured hepatocellular carcinoma (HCC) is the difficulty to achieve curative resection due to unplanned emergency operations, the hemodynamic instability, the frequent intrahepatic recurrence and the peritoneal seeding after resection for primary ruptured hepatocelluar carcinoma. Recent articles have suggested that well planned elective hepatic resection after hemodynamic stabilization of a ruptured HCC patient has a good prognosis, and repeat hepatic resection of recurred HCC has good prognosis when the liver function is good. We report here on patient who survived a long time with recurred HCC after 3 bouts of repeated hepatic resection for intrahepatic recurrences and 1 bout of right hemicolectomy for an omental recurrence. (ED note: now it shows good.)

Surgical Treatment of Ruptured Hepatocellular Carcinoma / 한국간담췌외과학회지

BACKGROUND/AIMS: Spontaneous rupture causing massive hemoperitoneum is a potentially life-threatening complication of hepatocellular carcionma (HCC). Hepatic resection provides the only hope of cure for patients with a ruptured HCC. So we reviewed our clinical experience with surgical treatments for ruptured HCC. METHODS: Between October 1990 and April 2003, twelve cases were treated with liver resection for ruptured HCC at our department. The clinical records were reviewed retrospectively. RESULTS: Twelve patients underwent hepatectomy. Ages ranged from 44 to 69 years with a mean age of 54.4 years, and sex ratio was 5:1 with a male dominence. Liver cirrhosis was presented in 9 cases (75%). 9 cases of them underwent staged hepatectomy; the other 3 underwent emergency hepatectomy. Three patients were treated by transcatheter arterial embolization (TAE) before staged hepatectomy. The median survival time were 40 (4~2) months, and overall 1-year and 3-year cumulative survival rates were 81% and 36%. CONCLUSION: Surgical resection is the only procedure associated with long-term survival for resectable ruptured HCC with good liver function. With or without preoperative TAE, elective hepatectomy is a rational treatment for patients with ruptured HCC.

Transcatheter hepatic arterial chemoembolization for spontaneously ruptured hepatocellular carcinoma / 中国微创外科杂志

Objective To investigate the practical value of transcatheter hepatic arterial chemoembolization (TACE) in the treatment of spontaneously ruptured hepatocellular carcinoma. Methods Using Seldinger technique,we treated 14 patients with ruptured hepatocellular carcinoma by TACE, in which a suspension of gelatin sponge, iodide oil and chemotherapeutic agents was used as embolus. Results Of 12 patients with active bleeding, successful hemostasis was achieved in 10 patients, with an effective rate of 83 3% (10/12), and 2 patients died from hemorrhagic shock within 48 hours, with an in-hospital mortality of 14 3% (2/14). One patient succumbed to hepatic failure two months after the TACE, and 1 patient received a radical operation two months after the TACE. Follow-up in 10 patients revealed that 8 patients underwent TACE for 1 ～ 4 times (mean survival time, 7 8 months) and 5 patients existed for more than 1 year (35 7%, 5/14). Conclusions TACE is effective in the management of spontaneously ruptured hepatocellular carcinoma.