Management, outcomes, and prognostic factors of ruptured hepatocellular carcinoma: A systematic review

Abstract

Ruptured hepatocellular (rHCC) is a rare but life-threatening presentation that often requires acute intervention. In this systematic review we identified 67 eligible studies reporting on 4941 patients with rHCC. Here we present the treatment approaches for the management of rHCC both in the acute setting with regards to management of hemorrhage, as well long-term with regards to oncological treatment.

Abandonment of surveillance, followed by emergency surgery for a second spontaneous rupture of hepatocellular carcinoma: A case report and review of the literature

“…The hemodynamic status of the patient is the main factor in clinical algorithms . In unstable patients, resuscitation and hemostasis are the primary concern . TAE, surgical hemostasis or emergency liver resection could achieve the latter .…”

“…The procedure was successful, and the bleeding stopped. After a brief period of recovery, definitive therapy was considered . Four days after TAE, the patient underwent an elective anatomical resection of segment 6.…”

“…However, it failed, and the hemodynamically unstable patient was at once transferred to the operating room (OR). During emergency surgery, a midline laparotomy was performed, revealing an actively bleeding tumor in the left hemiliver and free peritoneal blood estimated at 2.5 L. The arterial branch of the left lateral section of the liver was ligated, and the bleeding stopped . A hematoma was evacuated from the abdominal cavity followed by closure of the laparotomy incision.…”

“…Patients with HCC present with a broad spectrum of disease that varies from early stages, often noticed at surveillance, to advanced lesions that can cause symptoms . One of the complications of HCC is the spontaneous rupture of a tumor (rHCC), which has a variable incidence and recently reported rates of 2.3%‐16% …”

“…Rupture of HCC can remain indolent without causing symptoms, but it can also lead to various degrees of abdominal pain and bleeding . Severe bleeding from rHCC is a potentially life‐threatening condition, and achieving hemostasis is the primary concern .…”