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

Abstract

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:

Factors Predicting Survival in Ruptured Hepatocellular Carcinoma Treated with Surgical Resection

“…Peritoneal recurrence was found only in 16.7% of patients in this study and this was comparable to previous studies which reported a rate between 11 -40% with median time to recurrence being 6 -11 months. [14][15][16][17][18] Ruptured HCC and time-to-surgery were the two most common deciding factors for peritoneal recurrence, however, there is some supportive and contradictive evidence regarding this. 14,15,19,20 Most ruptured HCC patients usually presented poor liver function and were excluded from liver resection.…”

Cancer Evo-Dev, a novel hypothesis derived from studies on hepatitis B virus-induced carcinogenesis

“…However, the risk of developing HCC is significantly higher in the oral nucleos(t)ide analoguescomplete responder group compared with the inactive CHB group, regardless of the presence of baseline liver cirrhosis [4] , indicating that continuous active inflammation in liver facilitates the development of HCC. Although surgical technologies for the treatment of liver cancer have been improved, postoperative prognosis remains to be precisely evaluated [5][6][7] . Active inflammation on chronic inflammation background, as reflected by an Ishak hepatic inflammation score (> 6), a higher neutrophil-tolymphocyte ratio (> 5), and a higher C-reactive protein in sera (> 0.3 mg/dL), etc., also indicate a poor postoperative prognosis such as postoperative recurrence and shorter recurrence-free survival in HBV-related HCC (HBV-HCC) patients [8,9] .…”