Distilled Water Lavage During Surgery Improves Long-Term Outcomes of Patients with Ruptured Hepatocellular Carcinoma

Zhou, Shun; Zhang, Erlei; Liang, Benjia; Zhang, Zunyi; Chen, Xiaoping; Huang, Zhiyong

doi:10.1007/s11605-015-2797-0

Cited by 24 publications

(31 citation statements)

References 17 publications

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“…Searching the reference list (snowball procedure) retrieved two additional articles. In total, 67 studies were deemed eligible and therefore included in the systematic review …”

Section: Resultsmentioning

confidence: 99%

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

Moris

Chakedis

Sun

et al. 2017

Journal of Surgical Oncology

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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.

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“…Searching the reference list (snowball procedure) retrieved two additional articles. In total, 67 studies were deemed eligible and therefore included in the systematic review …”

Section: Resultsmentioning

confidence: 99%

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

Moris

Chakedis

Sun

et al. 2017

Journal of Surgical Oncology

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“…42,92 Moreover, intraperitoneal seeding of HCC is not uncommon following rupture of HCC and has been reported to be as high as 9.4-20%. [93][94][95] Peritoneal lavage with distilled water or instillation of 5-Fluoro-uracil after liver resection has been shown to reduce the chances of tumor recurrences. Peritoneal lavage with distilled water during surgery was also found to be associated with significantly better Disease Free Survival (DFS) and OS in patients after HCC rupture.…”

Section: Other Rare Techniques Of Hemostasismentioning

confidence: 99%

“…Peritoneal lavage with distilled water during surgery was also found to be associated with significantly better Disease Free Survival (DFS) and OS in patients after HCC rupture. [93][94][95] Due to the above reasons and the potential risk of disease recurrence, LT in ruptured HCC seems an unreasonable option. The Current United Kingdom listing criteria for LT for HCC also consider ruptured HCC as an absolute contraindication.…”

Section: Other Rare Techniques Of Hemostasismentioning

confidence: 99%

Rupture of Hepatocellular Carcinoma: A Review of Literature

Sahu

Chawla

Dhiman

et al. 2019

Journal of Clinical and Experimental Hepatology

104

110

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Approximately 700,000 people die of Hepatocellular Carcinoma (HCC) each year worldwide, making it the third leading cause of cancer related deaths. Rupture is a potentially life-threatening complication of HCC. The incidence of HCC rupture is higher in Asia and Africa than in Europe. In Asia approximately 10% of patients with a diagnosis of HCC die due to rupture each year. Spontaneous rupture is the third most common cause of death due to HCC after tumor progression and liver failure. The diagnosis of rupture in patients without history of cirrhosis or HCC may be difficult. The most common symptom of ruptured HCC is abdominal pain (66-100%). Shock at presentation can be seen in 33-90% of cases; abdominal distension is reported in 33%. Abdominal paracentesis documenting hemoperitoneum is a reliable test to provisionally diagnose rupture of HCC, it can be seen in up to 86% of clinically suspected cases. The diagnoses can be confirmed by computed tomography scan or ultrasonography, or both in 75% of cases. Careful pre-treatment evaluation is essential to decide the best treatment option. Management of ruptured HCC involves multidisciplinary care where hemostasis remains a primary concern. Earlier studies have reported a mortality rate of 25-75% in the acute phase of ruptured HCC. However, recent studies have reported a significant decrease in the incidence of mortality. There is also a decrease in the incidence of ruptured HCC due to improved surveillance and early detection of HCC. Transarterial Embolization is the least invasive method to effectively induce hemostasis in the acute stage with a success rate of 53-100%. Hepatic resection in the other hand has the advantage of achieving hemostasis and in the same go offers a potentially curative resection in selected patients. (J CLIN EXP HEPATOL 2019;9:245-256) INCIDENCE The reported incidence of HCC rupture shows a distinct global variation. In the West, the incidence of HCC is increasing but HCC ruptures are relatively uncommon, with an incidence of less than 3%. 12-14 However, in Asia and Africa, the incidence is considerably higher, ranging between 3% and 26%. 14,15 The incidences of ruptured HCC reported from around the globe are 10% from Japan, 12.4% from Thailand, 12.7% from southern Africa, 14.5% from

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“…According to the above-stated articles regarding the usage of distilled water for mitigating symptoms of fluid collection, distilled water does not cause severe adhesion despite its cytocidal property. [9][10][11][12][13] In these reports, any severe complications associated with use of distilled water have not been described other than mild serum mineral imbalances caused by dilution of serum due to distilled water absorbed through peritoneum/pleura. Because sclerosant use of distilled water requires a much smaller amount compared to perfusate use, sclerosant use of distilled water seems quite safe.…”

Section: Discussionmentioning

confidence: 99%

“…Use of DWL for the present case was approved by the Ethics Committee of the Yokohama Ekisaikai Hospital because its use was considered in accordance with the ethical guidelines for epidemiologic research in Japan based on previous reports regarding use of DWL in clinical settings. [8][9][10][11][12][13] A 63-year-old postmenopausal woman with PLD developed severe abdominal fullness and edema of lower extremities. Her PLD was not accompanied by polycystic kidneys because no cystic lesions were found in her kidneys.…”

Section: Methodsmentioning

confidence: 99%

Utilization of Distilled Water Lavage for Localized Fluid Collection After Combined Hepatectomy and Cyst Fenestration for Polycystic Liver Disease

Yamaguchi

Morioka

Kobayashi

et al. 2016

International Surgery

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Ascites necessitating persistent drainage or paracentesis after drain removal has been found among early postoperative complications after combined hepatectomy and cyst fenestration (CHCF) for polycystic liver disease (PLD). It has been reportedly observed in 20% to 70% of cases and seemed to easily cause recurrent symptoms unless properly treated. We utilized distilled water lavage for treating localized fluid collection after combined hepatectomy and cyst fenestration for PLD. A 63-year-old female patient underwent CHCF for PLD, which caused severe abdominal fullness. Early postoperative course was uneventful until 10 days after surgery when the patient suffered sudden abdominal fullness and resultant severe anorexia because of right subphrenic massive localized monolocular fluid collection diagnosed by abdominal computed tomographyalthough total liver volume was reduced to less than half of that before surgery. Percutaneous drainage relieved symptoms immediately, but the drainage tube could not be removed because of massive outflow. Then we utilized distilled water lavage for treating this condition. After that, drain outflow dramatically reduced and the drainage tube was successfully removed. Total liver volume of the patient continued to reduce up to 1 year after surgery and retained less than one-third of preoperative total liver volume thereafter. Sustained reduction of total liver volume in the present case suggested a sclerosant effect of hypotonic cytocidal property of distilled water for cyst endothelium and/or retrieved effectiveness of fenestration. Hence, we consider this approach to be useful for patients with PLD receiving CHCF and thus present it here.

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Distilled Water Lavage During Surgery Improves Long-Term Outcomes of Patients with Ruptured Hepatocellular Carcinoma

Cited by 24 publications

References 17 publications

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

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

Rupture of Hepatocellular Carcinoma: A Review of Literature

Utilization of Distilled Water Lavage for Localized Fluid Collection After Combined Hepatectomy and Cyst Fenestration for Polycystic Liver Disease

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