Spontaneous Rupture of Hepatocellular Carcinoma

Leung, Aaron Kam-Lun; Lau, W. Y.; Lai, Paul B.S.; Yiu, Raymond Y. C.; Meng, Wei; Leow, C. K.

doi:10.1001/archsurg.134.10.1103

Cited by 58 publications

(25 citation statements)

References 9 publications

(10 reference statements)

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“…However, the majority of our patients treated by TACE die within the first year from tumour progression. Our study confirms that delayed resection was the only treatment associated with a long-term survival in the subgroup of patients with good liver function and resectable tumour [1, 6, 8, 9]. In this subgroup of patients, TACE allows an accurate radiological evaluation before planning the resection.…”

Section: Discussionsupporting

confidence: 79%

Management of Spontaneous Rupture of Liver Tumours

Marini¹,

Vilgrain

Belghiti³

2002

Dig Surg

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Spontaneous ruptures of a liver tumour are often considered as a potentially life-threatening situation. The aim of the present study was to evaluate both clinical features and treatment in a subgroup of patients with ruptured liver tumours. From 1995 to 2000, 20 patients were referred to our centre for spontaneous rupture of a liver tumour associated with haemoperitoneum. Hepatocellular carcinoma (HCC) was present in 13 patients (11 men and 2 women) aged from 48 to 72 years (mean 62) and adenoma in 7 women aged from 23 to 52 years (mean 35). Although all patients experienced sudden abdominal pain and anaemia, shock at admission was present in 4 (20%) patients including 3 with HCC. In patients with HCC, severe liver insufficiency (Child-Pugh C) was present in 5 cases including the 3 shocked patients. No treatment was undertaken in 2 patients, transarterial embolization was performed in 9 cases and 5 patients underwent delayed resection. In hospital, mortality was observed in 3 (23%) patients, all of them had severe liver insufficiency. Long-term survival was observed in patients with good liver function who underwent resection. In patients with adenoma, shock at admission was observed in only 1 patient under anticoagulation treatment. Emergency resection was performed in 3 cases. A decrease of the tumour size was observed in patients who underwent delayed resection resulting in a lower rate of peri-operative transfusion. In conclusion, this study confirms that the majority of patients with ruptured liver tumours had no evidence of haemodynamic instability and therefore should be initially managed conservatively. In patients with single ruptured HCC associated with good liver function, long-term survival can be observed after liver resection. Delayed resection facilitated the operative procedure in patients with ruptured adenoma.

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Section: Discussionsupporting

confidence: 79%

Management of Spontaneous Rupture of Liver Tumours

Marini¹,

Vilgrain

Belghiti³

2002

Dig Surg

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“…The hemostatic procedure can either be an open surgical approach or TAE. 18 reported a retrospective study on 112 patients with ruptured HCC. In this study, the outcome of patients treated by a conservative approach was compared with an aggressive approach.…”

Section: Conservative Treatmentmentioning

confidence: 99%

“…12,18,19,[50][51][52][53][54][55][56][57] In the medical literature, there is no study, to our knowledge, on the optimal time to carry out staged liver resection. The time ranged from 10 to 126 days.…”

Section: One-stage Emergency Liver Resection Vs Staged Liver Resectionmentioning

confidence: 99%

Spontaneous Rupture of Hepatocellular Carcinoma

Lai¹

2006

Arch Surg

211

270

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To review the management of spontaneous ruptured hepatocellular carcinoma in the acute phase, the definitive treatment after hemostasis, and the prognosis. Data Sources: A MEDLINE search was undertaken to identify articles in English from 1970 to 2004 using the key words "hepatocellular carcinoma," "spontaneous rupture," "therapeutic embolization," and "laparoscopy." Additional articles were identified by a manual search of the references from the key articles.Study Selection: There were no exclusion criteria for published information on the topics.Data Extraction: All studies that contained material applicable to the topic were considered.Data Synthesis: In the acute phase, transarterial embolization for hemostasis has a high success rate (53%-100%). It has a lower 30-day mortality rate than open surgical methods (0%-37% vs 28%-75%). For the definitive treatment, staged liver resection has a higher resection rate (21%-56% vs 13%-31%) and a lower in-hospital mortality rate (0%-9% vs 17%-100%) than 1-stage emergency liver resection. Staged liver resection has a good survival rate (1-year survival, 54.2%-100%; 3-year survival, 21.2%-48%; 5-year survival, 15%-21.2%).Conclusions: Transarterial embolization is effective in controlling bleeding from ruptured hepatocellular carcinoma in the acute phase. The serum bilirubin level, shock on hospital admission, and prerupture disease state are important prognostic factors to predict survival in the acute phase. For definitive treatment, staged liver resection after attaining hemostasis is better than 1-stage emergency liver resection. Laparoscopy and laparoscopic ultrasonography may decrease unnecessary exploratory laparotomy, thus increasing the resection rate of previously ruptured hepatocellular carcinoma. Prolonged survival can be achieved in select patients with definitive treatment. It is still uncertain whether the long-term outcome of liver resection is the same for hepatocellular carcinoma with and without rupture when patients with the same tumor stage and liver functional state are compared.

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“…Tumor size and superficial location are possible risk factors for rupture [16]. The mortality rate of this severe complication is very high (25-75%) [4,12,13,[17][18][19][20].…”

Section: Introductionmentioning

confidence: 99%

Prognosis of patients with spontaneous rupture of hepatocellular carcinoma in cirrhosis

et al. 2011

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The treatment of cirrhotic patients with spontaneous rupture of hepatocellular carcinoma (HCC) is controversial and largely dependent on general conditions of the patients and compensation of the underlying cirrhosis. We retrospectively reviewed clinical, imaging and surgical records of 24 consecutive cirrhotic patients (17 males, 7 females; age range 52-88 years) with hemoperitoneum from spontaneous rupture of HCC observed from June 2004 to January 2010 at our Institution. When indicated, patients were referred to surgery or trans-arterial embolization (TAE). Advanced decompensated patients were conservatively treated and clinically followed up. Spontaneous rupture of HCC was assessed by aspiration of bloody ascites at paracentesis in all cases. The presence of large blood-clots over HCC and liver surface at US and/or CT was considered a specific sign of ruptured HCC in 14 cases. In two out of four patients who underwent TAE active bleeding from tumor surface could be demonstrated. In 2 cases, the active hemorrhage from the HCC surface could be assessed by contrast-enhanced ultrasonography. Four out of 24 patients underwent surgery. Three out of four of these patients died within 2 weeks, 8 months, and 20 months after operation, respectively. The remaining patient is still alive at 52 months follow-up. Four patients underwent TAE and died at 1, 2, 6 and 10 months after treatment, because of recurrent peritoneal bleeding and/or liver failure. Sixteen patients with ruptured HCC in the advanced Child C cirrhosis were treated conservatively with blood derivative transfusion and with procoagulant drugs. All patients, but one died within 2-18 days. One patient survived the acute hemorrhage from ruptured HCC and died of liver failure after 3 months. We concluded that spontaneous rupture of HCC is usually a fatal event in patients with poor liver function, even after successful TAE. In compensated patients, timely surgical treatment can result in long term and even tumor-free survival of the patient.

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Spontaneous Rupture of Hepatocellular Carcinoma

Cited by 58 publications

References 9 publications

Management of Spontaneous Rupture of Liver Tumours

Management of Spontaneous Rupture of Liver Tumours

Spontaneous Rupture of Hepatocellular Carcinoma

Prognosis of patients with spontaneous rupture of hepatocellular carcinoma in cirrhosis

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