Spontaneous Rupture of Hepatocellular Carcinoma

Abstract

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.

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

“…The incidence of HCC rupture is higher in Asia than in Western countries, ranging from 2.3% to 26% in Asia compared with less than 3% in the West 4, 5. The incidence of HCC rupture in our study was 5.3%, lower than in a 1995 study in Taiwan (26%) 13.…”

“…The incidence of HCC rupture in our study was 5.3%, lower than in a 1995 study in Taiwan (26%) 13. Other studies reported that ruptured HCC is associated with high in‐hospital mortality, above 25% 4, 5. In the current study, 23% of the patients with tumor ruptures died during their hospital stays.…”

“…In addition, there was a high in‐hospital mortality rate (45.7%) for patients with tumor rupture and shock (RS group). Previous studies showed that increased mortality among patients with HCC is related to cirrhosis, high Child‐Pugh score, poor liver function (low serum albumin, high serum bilirubin, AST or ALT levels), and severity of bleeding (shock and low hemoglobin level) 4, 5, 14, 15.…”

“…Transarterial embolization is an effective method for achieving prompt hemostasis and has a success rate of 53–100% 4, 5, 15, 16. After initial stabilization, the liver functional reserve and tumor stage should be investigated to determine the best treatment.…”

“…Spontaneous tumor rupture is a life‐threatening complication of HCC. Several studies reported poor prognosis of patients with ruptured HCC, with median survival period of 7–21 weeks and a 1‐month mortality rate of 34–71% 3, 4, 5. Studies of hepatectomy patients showed those with ruptured HCC had worse prognosis than those with non‐ruptured HCC 6, 7.…”