Emergency Resection of a Bleeding Ruptured Malignant Phyllodes Tumor of the Breast.

Ruptured phyllodes tumors, though extremely rare, can necessitate emergency surgery in certain cases, particularly those with active bleeding. A 51-year-old woman presented to our hospital with a newly identified mass in her right breast that developed over the past two months. The tumor had ruptured through the paramammary nipple. While initially diagnosed with a phyllodes tumor and scheduled for elective surgery, she experienced active bleeding from the ruptured tumor, leading to a drop in hemoglobin levels. An emergency right simple mastectomy was performed to control the bleeding. Postoperatively, no complications or recurrences were observed. Phyllodes tumors, which are characterized by rapid growth, may present with active bleeding following rupture and may require emergency surgery.

Early versus Delayed Hepatectomy for Spontaneously Ruptured Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis.

OBJECTIVE: Here, we aimed to compare early hepatectomy (EH) with delayed hepatectomy (DH) as a treatment for spontaneously ruptured hepatocellular carcinoma (HCC). METHODS: Several databases were systematically searched for eligible studies that compared DH with EH for spontaneously ruptured HCC treatment. Studies that met the inclusion criteria were reviewed systematically, and the reported data were aggregated statistically, using the RevMan v5.3 software. RESULTS: Seven studies were included, with a total of 385 patients, comprising of 224 EH cases and 161 DH cases. Compared with the EH group, incidence of intraoperative bleeding [mean difference (MD), 353.93; 95% CI, 230.04-447.83; P < 0.00001], volume of intraoperative blood transfusion (MD, 420.61; 95% CI, 354.40-486.81, P < 0.00001), and 30-day mortality rate (OR, 14.94; 95% CI, 1.76-126.66; P = 0.01) were significantly lower in the DH group. Furthermore, the 1-, 2-, and 3-year survival rates were significantly higher in the DH group [1-year：hazard ratio (HR), 1.76; 95% CI, 1.06-2.94; P = 0.03; 2-year：HR, 1.52; 95% CI, 1.02-2.25; P = 0.04; 3-year: HR, 1.53; 95% CI, 1.06-2.21; P = 0.02]. There was no difference between the groups in the 5-year survival rate (HR, 1.40; 95% CI, 0.92-2.11; P = 0.11). CONCLUSION: For resectable spontaneously ruptured HCC, DH could reduce intraoperative bleeding, intraoperative blood transfusion volume, and 30-day mortality rate and increase the 1-, 2-, and 3-year survival rates, endowing the patients with greater short- and long-term benefits during and following the surgery.

Continuous occlusion of hepatic artery for prevention of blood loss in partial hepatectomy for ruptured hepatocellular carcinoma / 中华消化外科杂志

Objective To investigate the value of continuous occlusion of hepatic artery proper to intermittent Pringle maneuver in partial hepatectomy for ruptured hepatocellular carcinoma(HCC).Methods The clinical data of 36 patients(test group)who received partial hepatectomy for ruptured HCC by adding continuous occlusion of hepatic artery proper to intermittent Pringle maneuver at the Southwest Hospital were retrospectively analyzed.Thirty-six patients(control group)who received intermittent Pringle maneuver only were selected as the control.All data were analyzed using the chi-square test,Fisher exact probability and analysis of variance.Results The mean hepatic artery occlusion time of the test group was 58 minutes(range,36-98 minutes).The median blood loss of the test group was 400 ml,which was significantly less than 750 ml of the control group(F =16.47,P ＜ 0.05);78%(28/36)of patients in the test group did not receive blood transfusion,which was significantly more than 53%(19/36)of the control group(x2 =6.01,P ＜0.05).The levels of postoperative serumaspartate transaminase and total bilirubin of the 2 groups were peaked at postoperative day 2 and then decreased to the normal level 1 week later.There were no significant differences in the incidences and levels of complications between the 2 groups(x2 = 1.83,0.89,P ＞ 0.05).Conclusion The addition of continuous occlusion of hepatic artery proper to intermittent Pringle maneuver significantly reduces intraoperative blood loss and doesn't bring any adverse effects to hepatic function for partial hepatectomy in patients with ruptured HCC when compared with intermittent Pringle maneuver alone.