Ruptured Hepatocellular Carcinoma: What Do Interventional Radiologists Need to Know?

Abstract

Rupture of HCC (rHCC) is a life-threatening complication of hepatocellular carcinoma (HCC), and rHCC may lead to a high rate of peritoneal dissemination and affect survival negatively. Treatment for rHCC mainly includes emergency surgery, interventional therapies, and palliative treatment. However, the management of rHCC should be carefully evaluated. For patients with severe bleeding, who are not tolerant to open surgery, quick hemostatic methods such as rupture tissue ablation and TAE/TACE can be performed. We described clinical presentation, prognosis, complication, interventional management, and current evidence of rHCC from the perspective of interventional radiologists. Overall, our review summarized that interventional therapies are necessary for most patients with rHCC to achieve hemostasis, even in some patients with Child–Pugh C. Moreover, TAE/TACE followed by staged hepatectomy is a beneficial treatment for rHCC according to current clinical evidence. TAE/TACE is the first choice for most patients with rHCC, and appropriate interventional treatment may provide staged surgery opportunities for those who are not tolerant to emergency surgery to reach an ideal prognosis.

Selective Arterial Embolization of Ruptured Hepatocellular Carcinoma with N-Butyl Cyanoacrylate and Lipiodol: Safety, Efficacy, and Short-Term Outcomes

“…Most of our patients had cirrhosis without clinically significant coagulopathy. The main cause of cirrhosis was alcohol abuse, compared to hepatitis B in populations studied in Asia [14]. The HCC was known before the rupture in only two of our 16 patients.…”

“…The management of rHCC is aimed at ensuring patient survival by controlling the bleeding, with treatment of the tumor being provided only once the acute episode is controlled [14][15][16][17][18]. In the absence of surgical or radiological intervention, rHCC is often fatal due to bleeding and disease progression.…”

A Rare Case of Hepatocellular Carcinoma Presenting as a Massive Abdominal Hematoma and Shock: A Case Report

“…Not detecting and controlling early can lead to shock and death [ 10 ]. As it has a poor prognosis, it must be a differential diagnosis in patients with higher levels of liver dysfunction [ 11 ]. Despite the poor prognosis, some studies show that emergency laparotomy is detrimental to patient survival [ 12 ].…”

Transarterial chemoembolization for advanced hepatocellular carcinoma without macrovascular invasion or extrahepatic metastasis: analysis of factors prognostic of clinical outcomes

“…The present study also showed that tumor rupture was associated with poor prognosis after TACE. Previous studies have yielded conflicting results on whether tumor rupture is a poor prognostic factor and on the role of TACE in patients with tumor rupture ( 27 , 28 ). Based on recently reported data on equivalent survival outcomes in patients with ruptured HCC, the Sixth edition of the Liver Cancer Study Group of Japan (LCSGJ) guidelines does not consider tumor rupture in T staging.…”