Ruptured hepatocellular carcinoma following trans catheter arterial chemoembolization

Brüls, Samuel; Joskin, Julien; Chauveau, R; Delwaide, Jean; Meunier, Paul

doi:10.5334/jbr-btr.497

Cited by 7 publications

(4 citation statements)

References 16 publications

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“…7 Chearanai et al 13 reported that bleeding from a laceration in a superficially located tumor secondary to minimal trauma, triggered by an external event or normal respiratory movement, can cause rupture, especially when the tumor is situated under the right diaphragm. Bruls et al 42 reported a case of ruptured HCC occurring after transarterial chemoembolization (TACE). Necrotic tumor rupture is a serious complication of TACE.…”

Section: Tumor-node-metastasis (Tnm) Classificationmentioning

confidence: 99%

Spontaneous ruptured hepatocellular carcinoma

Yoshida

Mamada

Taniai

et al. 2015

Hepatology Research

109

143

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The incidence of hepatocellular carcinoma (HCC) is rising worldwide. Spontaneous rupture of HCC occasionally occurs, and ruptured HCC with intraperitoneal hemorrhage is potentially life-threatening. The most common symptom of ruptured HCC is acute abdominal pain. The tumor size in ruptured HCC is significantly greater than that in non-ruptured HCC, and HCC protrudes beyond the original liver margin. In the acute phase, hemostasis is the primary concern and tumor treatment is secondary. Transcatheter arterial embolization (TAE) can effectively induce hemostasis. The hemostatic success rate of TAE ranges 53-100%. A one-stage surgical operation is a treatment modality for selected patients. Conservative treatment is usually given to patients in a moribund state with inoperable tumors and thus has poor outcomes. Patients with severe ruptures of advanced HCC and poor liver function have high mortality rates. Liver failure occurs in 12-42% of patients during the acute phase. In the stable phase, tumor treatment, such as transarterial chemoembolization or hepatic resection should be concerned. The combination of acute hemorrhage and cancer in patients with ruptured HCC requires a two-step therapeutic approach. TAE followed by elective hepatectomy is considered an effective strategy for patients with ruptured HCC.

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Section: Tumor-node-metastasis (Tnm) Classificationmentioning

confidence: 99%

Spontaneous ruptured hepatocellular carcinoma

Yoshida

Mamada

Taniai

et al. 2015

Hepatology Research

109

143

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“…2,3,6,[12][13][14] Studies have also suggested that ischemic necrosis or vascular injury related to treatment can precipitate rupture. 17,[27][28][29][30] Zhu et al 31,32 suggested that tumor rupture maybe related to vascular dysfunction especially when blood vessels encounter high blood pressure or mechanical injury, although the hypothesis was not well investigated. Chearanai et al 33 in a case series of 63 cases found that bleeding from a laceration in a superficial tumor, especially if located under the right diaphragm, secondary to minimal trauma, or even normal respiration can cause tumor rupture.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Rupture of Hepatocellular Carcinoma: New Insights

Obeidat

2022

Journal of Clinical and Experimental Hepatology

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Background: Spontaneous rupture of hepatocellular carcinoma (HCC) is a potentially fatal complication and the third leading cause of death in patients with HCC after tumor progression and liver failure. Previous studies suggested that improved HCC surveillance has decreased the incidence of rupture. This study aims to characterize patients with ruptured HCC over time and identify predictors of rupture. Methods: We retrospectively reviewed a prospectively collected database of 1451 HCC patients to identify cases with rupture and predictors of rupture. Data were divided into three 9-year eras to compare and trend patient/tumor characteristics and rupture. Results: Fifty-seven patients (3.9%) presented with spontaneous HCC rupture and the following characteristics: mean age 62.6 years, 73.7% males, 41% cirrhosis, and mean tumor size of 8.0 cm. On multivariate analyses, predictors of rupture included obesity, tumor >5 cm, and single tumors, whereas the presence of cirrhosis was a negative predictor for rupture.Across three eras, there were changes in disease etiology and decreases in tumor size, and more HCCs were found with surveillance. However, more patients were noncirrhotic, and the incidence of spontaneous rupture was unchanged over time. Conclusion: Despite improved early detection of HCC over time, the incidence of rupture has been unchanged. The persistent incidence of rupture may possibly be attributed to increasing proportion of fatty liver-related HCC patients who lack traditional risk factors for surveillance and may not have cirrhosis. Better identification of fatty liver disease and determining which patients need HCC surveillance may be needed in the future to prevent spontaneous rupture.

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“…Although post‐embolization syndrome occurs in up to 20% of the patients after TACE, many of the symptoms are transient and well tolerated 1 . Complications such as hepatic insufficiency, tumour rupture and abscess formation are uncommon 1,2 …”

Section: Figmentioning

confidence: 99%

“…1 Complications such as hepatic insufficiency, tumour rupture and abscess formation are uncommon. 1,2 Herein, we report a rare post TACE complication of delayed diaphragmatic hernia.…”

mentioning

confidence: 95%