Spontaneous rupture of hepatocellular carcinoma: a Western experience

Battula, Narendra; Madanur, Mansoor; Priest, Oliver; Srinivasan, Parthi; O’Grady, John; Heneghan, Michael A.; Bowles, Matthew; Muiesan, Paolo; Heaton, Nigel; Rela, Mohamed

doi:10.1016/j.amjsurg.2007.10.016

Cited by 93 publications

(113 citation statements)

References 17 publications

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“…Although some studies reported successful TACE in patients with main portal venous thrombosis but with preserved liver function and good collateral circulation, patients with ruptured HCC generally have poorer hepatic functional reserve, therefore portal venous thrombosis may be related to their poor outcome 5, 21. The presence of shock, a marker for the severity of a hemorrhage from a tumor rupture, is related to short‐term mortality 4, 5, 15, 22, 23. Our study, however, showed that the R group had a worse outcome than the RS group.…”

Section: Discussionmentioning

confidence: 99%

Impact of spontaneous tumor rupture on prognosis of patients with T4 hepatocellular carcinoma

Chan

Hung

Pan

et al. 2016

Journal of Surgical Oncology

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Background and objectivesCompare the outcomes of three groups of patients with T4 hepatocellular carcinoma (HCC): tumor rupture with shock (RS group), tumor rupture without shock (R group), and no tumor rupture (NR group).Materials and MethodsWe retrospectively reviewed 221 patients with T4 HCC from 2010 to 2012. The clinical background and prognosis were analyzed.ResultsOverall in‐hospital mortality rate was 18.1%; overall median survival time was 4 months. The NR group were more likely to have multiple and infiltrative tumors (P < 0.001). Relative to the NR group, the R + RS group had better survival rates at 6 months (49.2% vs. 32.2%), 1 year (35.3% vs. 21.0%), 3 years (22.5% vs. 11.0%), and 5 years (17.7% vs. 5.5%) (P = 0.010). Patients in the RS group had a higher in‐hospital mortality rate, but significantly better long‐term survival than the NR and R group (P < 0.001). Multivariate analysis indicated that Child‐Pugh class B or C, presence of portal venous thrombosis, and absence of shock were significantly associated with poor survival.ConclusionPatients with tumor rupture and shock had worse in‐hospital survival. However, patients without decompensated liver cirrhosis and portal venous thrombosis, and eligible for curative treatment had favorable long‐term outcome. J. Surg. Oncol. 2016;113:789–795. © 2016 The Authors. Journal of Surgical Oncology Published by Wiley Periodicals, Inc.

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Section: Discussionmentioning

confidence: 99%

Impact of spontaneous tumor rupture on prognosis of patients with T4 hepatocellular carcinoma

Chan

Hung

Pan

et al. 2016

Journal of Surgical Oncology

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“…Some groups have argued that TACE should be the first treatment for these patients due to their advanced stage, poor overall prognosis, large tumor volume, impaired liver function, and implantation metastasis (Li et al, 2009;Toshikuni et al, 2011;Shin et al, 2011). However, other studies have reported a survival benefit from staged hepatectomy in these cases (Battula et al, 2009;Miyoshi et al, 2011). In this study, we compared the long-term outcomes of ruptured HCC cases that underwent hepatic resection or TACE after successful TAE as the initial therapy for hemostasis.…”

Section: Patients With Spontaneously Ruptured Hepatocellular Carcinommentioning

confidence: 99%

“…Some investigators have correlated spontaneous rupture with vascular dysfunction in the tumor tissue and have identified portal hypertension and/or minor mechanical injury as risk factors (Zhu et al, 2004). Rupture occurs in certain small tumors and at a higher frequency in large tumors (Battula et al, 2009). In our present study, 16 tumors displaying a diameter of less than 5 cm ruptured, and these patients represented 12.7% of all patients experiencing rupture.…”

Section: Discussionmentioning

confidence: 99%

Patients with Spontaneously Ruptured Hepatocellular Carcinoma Benefit from Staged Surgical Resection after Successful Transarterial Embolization

Zhang¹,

Zhang²,

Wang³

et al. 2015

Asian Pacific Journal of Cancer Prevention

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Background: Surgical resection of spontaneously ruptured hepatocellular carcinoma (HCC) after successful transarterial embolization (TAE) remains controversial. The aim of this study was to investigate its efficacy in a series of cases. Materials and Methods: We retrospectively examined ruptured HCC cases from Jan 2000 to Dec 2008; all of these 126 cases received TAE as the initial therapy. Subsequently, 74 cases received staged surgical resection, and the remaining 52 cases underwent repeated TACE. The baseline demographic data, tumor characteristics, and long term survival were recorded and compared. Results: The demographic and baseline characteristics were comparable between the hepatic resection and TACE groups; furthermore, no significant difference in the tumor characteristics was detected between the two groups. The differences in in-hospital, 30-day and 90-day mortality between the two groups were not significant (P>0.05). However, the 1-, 3-, and 5-year overall survival rates were 85.1%, 63.5%, and 37.8%, respectively, in the hepatic resection group, which were significantly higher than those in the TACE group (69.2%, 46.2%, and 17.3%, respectively, P=0.004). Univariate and multivariate analyses indicated that these patients benefitted from hepatic resection compared with TACE with respect to long-term outcomes. Conclusions: Staged hepatic resection after TAE is an effective treatment that results in superior long-term survival to repeated TACE.

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“…In these cases, ultrasound reveals a large ([5 cm in diameter) inhomogeneous focal lesion in a patient with a history of cirrhosis, which is also obvious on imaging studies. The ruptured tumor is often subcapsular, and ultrasound discloses the presence of particulate ascites [4][5][6]. In this case, contrast-enhanced computed tomography (CT) should be done: it can confirm the presence of an HCC and demonstrate extravasation of the contrast medium into the high-density ascites fluid surrounding the lesion.…”

Section: Hepatocellular Carcinomamentioning

confidence: 99%

Acute nontraumatic liver lesions

Caremani¹,

Tacconi²,

Lapini³

2013

J Ultrasound

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The principal conditions requiring emergency/ urgent intervention in patients with nontraumatic liver lesions are hemorrhage (with or without tumor rupture), rupture of hydatid cysts (with or without infection), complications arising from liver abscesses or congenital liver cysts, rupture related to peliosis hepatis, and in rare cases spontaneous hemorrhage. This article examines each of these conditions, its appearance on ultrasound (the first-line imaging method of choice for assessing any urgent nontraumatic liver lesion) and indications for additional imaging studies.Keywords Acute liver disorders Á Ultrasound Á Contrast-enhanced ultrasound Sommario Le principali cause di emergenza/urgenza in patologia epatica non traumatica sono l'emorragia con o senza rottura di neoplasie epatiche, la rottura con o senza infezione delle cisti idatidee, le complicanze degli ascessi epatici, delle cisti congenite del fegato, l'emorragia, la rottura in corso di peliosi epatica e la rara emorragia spontanea. Dopo aver esaminato singolarmente le varie cause di emergenza/urgenza, i rispettivi aspetti ecografici e l'integrazione con altre metodiche di imaging si conclude che nei pazienti con patologia epatica l'ecografia, con o senza mezzo di contrasto, è la metodica da utilizzare in prima istanza ad ogni emergenza/urgenza non traumatica del fegato.

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Spontaneous rupture of hepatocellular carcinoma: a Western experience

Cited by 93 publications

References 17 publications

Impact of spontaneous tumor rupture on prognosis of patients with T4 hepatocellular carcinoma

Impact of spontaneous tumor rupture on prognosis of patients with T4 hepatocellular carcinoma

Patients with Spontaneously Ruptured Hepatocellular Carcinoma Benefit from Staged Surgical Resection after Successful Transarterial Embolization

Acute nontraumatic liver lesions

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