Patients with Spontaneously Ruptured Hepatocellular Carcinoma Benefit from Staged Surgical Resection after Successful Transarterial Embolization

Abstract

Background: Surgical resection of spontaneously ruptured hepatocellular carcinoma (HCC) after successful transarterial embolization (TAE) remains controversial. The aim of this study was to investigate its efficacy in a series of cases. Materials and Methods: We retrospectively examined ruptured HCC cases from Jan 2000 to Dec 2008; all of these 126 cases received TAE as the initial therapy. Subsequently, 74 cases received staged surgical resection, and the remaining 52 cases underwent repeated TACE. The baseline demographic data, tumor characteristics, and long term survival were recorded and compared. Results: The demographic and baseline characteristics were comparable between the hepatic resection and TACE groups; furthermore, no significant difference in the tumor characteristics was detected between the two groups. The differences in in-hospital, 30-day and 90-day mortality between the two groups were not significant (P>0.05). However, the 1-, 3-, and 5-year overall survival rates were 85.1%, 63.5%, and 37.8%, respectively, in the hepatic resection group, which were significantly higher than those in the TACE group (69.2%, 46.2%, and 17.3%, respectively, P=0.004). Univariate and multivariate analyses indicated that these patients benefitted from hepatic resection compared with TACE with respect to long-term outcomes. Conclusions: Staged hepatic resection after TAE is an effective treatment that results in superior long-term survival to repeated TACE.

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

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

“…The mean age of the study population was 55.6 years (SD = 6.64) with most patients being male (77.9%). A large portion of the cohort population consisted of patients from Asia, as 22 studies (33%) were from China, 17 (25%) from Japan, 10 (15%) from Taiwan, 5 (7.5%) from Korea, 2 (3%) from Thailand, and 1 (1.5%) each from Singapore and Malaysia . In contrast, studies about rHCC were less common from Western centers with only 2 reports (3%) from the Netherlands and Italy, and 1 (1.5%) each from Canada, France, United Kingdom, USA, and Nigeria .…”

Comparison of the prognostic influence of emergency hepatectomy and staged hepatectomy in patients with ruptured hepatocellular carcinoma

“…Once initial hemostasis after active supporting therapy is achieved, the patient will have a chance to undergo a staged hepatectomy. There are many clinical reports [8,18,19] that the therapeutic effect on staged hepatectomies after TAE hemostasis can be comparable to those procedures with these kinds of elective liver resection on non-ruptured HCC patients. This is also the best and most radical approach for patients with HCC ruptures.…”

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

“…Zhang et al [29] reported an 11.8% incidence of peritoneal disease in their series of ruptured HCCs. In the present study, there was an 11% peritoneal recurrence rate in the emergency hepatectomy group compared to 29% in the interval hepatectomy group (P = 0.27).…”

“…Zhang et al [29] reported on the impact of interval hepatectomy or repeat TACE after successful TACE for ruptured HCC. One hundred and twenty-six cases of ruptured HCC underwent TAE for haemostasis of which 74 had interval hepatectomy.…”