Treatment of ruptured hepatocellular carcinoma

Tanaka, Akira; Takeda, Ryoji; Mukaihara, Sumio; Hayakawa, Katsumi; Shibata, Toshiya; Itoh, Kyo; Nishida, Naoshi; Nakao, Kazuwa; Fukuda, Yoshihiro; Chiba, Tsutomu; Yamaoka, Yoshio

doi:10.1007/s10147-001-8030-z

Cited by 63 publications

(66 citation statements)

References 13 publications

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“…In the post-operative period, the complication rate was higher in the emergency group (44% vs. 38%) but there were no 30-day mortality or requirement for re-operative intervention in both groups. Emergency hepatectomy for ruptured HCC in patients with Child-Pugh C cirrhosis is associated with significant peri-operative mortality as reported in other case series, [20,23,27] but in this present study, 2 patients with Child-Pugh C cirrhosis underwent emergency hepatectomy without 30-day mortality. The favourable post-operative outcomes might be related to the short operation time (mean 146 min), small transection area (mean 35 cm 2 ) and no pre-operative angiogram and embolisation.…”

supporting

confidence: 45%

Outcomes of emergency and interval hepatectomy for ruptured resectable hepatocellular carcinoma: a single tertiary referral centre experience

Fung¹,

Chong²,

Lee³

et al. 2017

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How to cite this article: Fung AKY, Chong CCN, Lee KF, Wong J, Cheung YS, Fong AKW, Lai PBS. Outcomes of emergency and interval hepatectomy for ruptured resectable hepatocellular carcinoma: a single tertiary referral centre experience. Hepatoma Res 2017;3:196-204. Aim: The short and long term outcomes of patients who underwent emergency and interval hepatectomy for ruptured and resectable hepatocellular carcinoma (HCC) were analysed. Methods: The data of patients with ruptured HCC presenting between April 2004 and October 2015 were analysed. Emergency hepatectomy was defined as hepatectomy within 48 h of the clinico-radiological diagnosis of HCC rupture. Results: Thirty patients underwent hepatectomy for ruptured HCC. Nine (30%) patients underwent emergency hepatectomy. The median age was 56 and 54 years (P = 0.13) with a similar gender distribution. The mean HCC size (10.5 vs. 8.3 cm, P = 0.17), total blood loss (3,000 vs. 850 mL, P = 0.002) and total units of red blood cell transfusion (1.9 vs. 0.5 units, P = 0.27) were greater in the emergency hepatectomy group. The complication rate was 44% and 38% (P = 0.53), with median length of hospital stay of 10 and 12 days (P = 0.07) in the emergency and interval hepatectomy groups, respectively, and no 30-day mortality in both groups. The median overall survival was 29 and 15.7 months (P = 0.25), with survival rates of 78%, 45%, 0% and 85%, 43% and 5% at 1, 3 and 5 years in the emergency and interval hepatectomy groups, respectively. Conclusion: Hepatectomy should be considered for ruptured HCC provided the patient could tolerate curative resection. Key words:Hepatocellular carcinoma, rupture, hepatectomy ABSTRACTArticle history:

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supporting

confidence: 45%

Outcomes of emergency and interval hepatectomy for ruptured resectable hepatocellular carcinoma: a single tertiary referral centre experience

Fung¹,

Chong²,

Lee³

et al. 2017

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“…There is some controversy regarding the treatment of choice in this situation [33][34][35]. TAE and TACE are effective treatments to control the bleeding of ruptured HCC with mild blood loss [12].…”

Section: Discussionmentioning

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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“…Although TAE remains the best method to employ for haemostasis, it still has limitations. The rupture of HCC at an early phase in the development of liver fibrosis is a good indication for elective surgical treatment, and should be distinguished from rupture in the terminal phase of liver cirrhosis, which should be treated conservatively [12]. Although embolization is a common practice in these patients, the prognosis is still poor, due to profuse bleeding [13].…”

Section: Discussionmentioning

confidence: 99%

It is never too late: a deceitful gastric ulcer

et al. 2009

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Case presentationProf. Bruno: A 94-year-old woman was referred to our Emergency Department (ED) with a history of nausea, fatigue, sudden-onset epigastric pain and extreme discomfort. Before 1 h to the ED visit, she had syncope and three vomiting episodes. Before 5 years, she experienced a gastric haemorrhage.On admission, she showed hemodynamic shock with a blood pressure of 70/40 mmHg, she had a weak pulse, spoke slowly, and she was vague and slurred in her speech patterns. The 12-lead ECG showed a sinus tachycardia at 120 beats per minute. She was breathing rapidly at 27 breaths per minute and the non-invasive oxygen saturation (SpO 2 ) showed 85% while she was breathing room air. Her body temperature was 36.3°C. The finger-stick glucose was normal 105 mg%.Physical examination disclosed that the skin was cold with pallor. The lung fields were clear on auscultation; the abdomen was soft, but painful and tender. There were no hepatomegaly, no pulsating masses, or bruit was detectable. A rectal examination revealed no masses and no occult blood. The peripheral pulses were normal and symmetrical. She was treated with colloids, saline fluids and dopamine intravenously and as soon as possible, blood transfusions were begun.The results of routine laboratory findings, including ammoniemia, platelet count, liver function and clotting system (prothrombin, thromboplastin and clottable fibrinogen) were within normal ranges except for anaemia: her haemoglobin concentration was 7.9 g per decilitre and the haematocrit 22.6% with a mean corpuscular volume of 87.9 lm 3 . Serological markers for hepatitis B and C were negative.Her clinical condition stabilized following the blood transfusion and after oxygen administration. The cardiac output rose, and her blood pressure was 105/50 mmHg with a pulse rate of 89 beats per minute, respiratory rate 15 breaths/min and SpO 2 95% after the administration of oxygen by mask (4 L min -1 ). Therefore, it was possible to do an oesophagogastroscopy.Although 5 years before, she had a gastric haemorrhage, actually neither oesophageal varices nor peptic ulcer were observed during oesophagogastroscopy.The ultrasonogram concomitantly with the finding of no liver cirrhosis revealed a large mass involving the liver, free effusion in the abdomen, and an abdominal aortic aneurysm of 4 cm without signs of rupture.Abdominal computed tomography (CT) axial scan using intravenous contrast showed, in the caudal segments of the right liver lobe (segment VI), a 6 cm tumour bleeding from a spontaneous rupture, and a massive hemoperitoneum.

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Treatment of ruptured hepatocellular carcinoma

Cited by 63 publications

References 13 publications

Outcomes of emergency and interval hepatectomy for ruptured resectable hepatocellular carcinoma: a single tertiary referral centre experience

Outcomes of emergency and interval hepatectomy for ruptured resectable hepatocellular carcinoma: a single tertiary referral centre experience

Prognosis of patients with spontaneous rupture of hepatocellular carcinoma in cirrhosis

It is never too late: a deceitful gastric ulcer

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