Spontaneous Rupture of Hepatocellular Carcinoma and Vascular Injury

Zhu, Lizhi; Geng, Xiaoping; Fan, Sheung‐Tat

doi:10.1001/archsurg.136.6.682

Cited by 62 publications

(44 citation statements)

References 18 publications

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“…Spontaneous tumor rupture, a life-threatening situation for patients with large HCC, is also a known adverse prognostic factor after hepatic resection 7 . Spontaneous tumor rupture might be caused by the rapid expansion of the tumor, but the molecular mechanism of spontaneous tumor rupture is still not fully understood 21 . Transhepatic arterial embolization followed by hepatic resection has been proposed to be a rational treatment for the majority HCC patients with tumor rupture if the tumor could be resected 22 …”

Section: Discussionmentioning

confidence: 99%

A retrospective analysis of long term outcomes in patients undergoing hepatic resection for large (>5 cm) hepatocellular carcinoma

Zhao¹,

Wu²,

Liu

et al. 2016

HPB

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AimThe treatment of large (>5 cm) hepatocellular carcinoma (HCC) remains controversial. The aim of this study was to report short and long term outcomes and analyze the factors associated with long term survival for patients who underwent hepatic resection for large HCC.MethodsAll patients who underwent hepatic resection for large HCC at the department of Hepato-Pancreato-Biliary Surgery of the First Affiliated Hospital of Anhui Medical University between August 2005 and December 2011 were identified and included for analysis. Demographic and operative data, pathological findings and post-operative outcomes were entered into a computer database. Prognostic factors were analyzed by univariate and multivariate analysis.ResultsNinety-nine patients were included for analysis. Two patients died within 30 days of surgery secondary to hepatic failure. The 1-, 3-, 5-year disease-free survival and overall survival rates following hepatic resection were 67%, 49%, 37% and 77%, 56%, 43%, respectively. Poor histological grade was the only independent predictor of a reduced 5-year disease-free survival. Spontaneous tumor rupture and tumor recurrence were independent predictors of a reduced 5-year overall survival.ConclusionsFor selected patients with large HCC, hepatic resection can be performed safely and effectively with moderate expectation of long term survival. True cure however remains rare.

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Section: Discussionmentioning

confidence: 99%

A retrospective analysis of long term outcomes in patients undergoing hepatic resection for large (>5 cm) hepatocellular carcinoma

Zhao¹,

Wu²,

Liu

et al. 2016

HPB

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“…Hızlı tümör büyümesi nedeniyle oluşan santral nekroz, trombositopeni ve protrombin sentez bozukluğuyla ilişkili koagülopati, direkt tümör invazyonu nedeniyle ortaya çıkan venöz hipertansiyon, travma ve solunum hareketleriyle diafragmın yarattığı kompresyon literatürde spontan HSK rüptürü ile ilişkili olduğu düşünülen çeşitli mekanizmalar arasındadır [7,8]. HSK rüptürü tanısını koymak özellikle öncesinde siroz veya HSK tanısı olmayan hastalarda zordur [9].…”

Section: Discussionunclassified

Hepatosellüler karsinomada spontan intraperitoneal hemorajik rüptür: Olgu sunumu

Ulaş¹,

Özer²,

Öter³

et al. 2014

Cumhuriyet Med J

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ÖzetHepatosellüler karsinomun (HSK) intraperitoneal hemorajik rüptürü, ölümle seyredebilen bir komplikasyondur. Seçilmiş vakalarda ana tedavi seçenekleri cerrahi girişim ve arteriel embolizasyondur. Bu yazıda hepatosellüler karsinomun spontan rüptürü sonrası gelişen intraperitoneal kanamalı olgu sunulmuştur. Karın ağrısı ve hemorajik şok tablosunda dış merkezde acile başvurmuş 70 yaşında bir erkek hastadır. Karaciğerde intraperitoneal hemorajik rüptüre kitle nedeni ile sütür ile hemostaz ve packing ile ilk müdahalesi yapılan hasta daha sonra tarafımızca genel durumu ve vital bulguları düzeltilerek tekrar operasyona alınmış depacking sonrası karaciğer segment 4b rezeksiyonu ve kolesistektomi operasyonu yapılmıştır. Hastanın postoperatif dönemde patoloji sonucu iyi differansiye hepatosellüler karsinom olarak gelmiş olup bu olguda olduğu gibi yeterli tıbbi ve teknik ekipman olmadığında ilk cerrahi müdahale (sütürasyon ile hemostaz ve packing) sonrası ileri bir merkezde elektif cerrahi tedavi yaklaşımı da hayat kurtarıcı olabilir. Anahtar sözcükler: Hepatosellüler karsinoma, spontan rüptür, tedavi Abstractİntraperitoneal hemorajic rupture is a complication of hepatocellular carcinoma that can be mortal. Surgical management and arterial embolisation are the main therapy choices in selected cases. We presented a case of hepatocellular carcinoma with spontaneous rupture and intra-abdominal hemorrhage. A 70 years old male was admitted to emergency department with abdominal pain and unstable hemodynamy. Patient was taken the operation room due to intra-abdominal bleeding. İntraoperatif diagnosis was rupture haemorrhagic solid liver mass and they performed depacking and hemostasis. Then they decided to transport patient to our hospital (tertiary hospital). We perform depacking, liver segment resection (4b) and cholecystectomy operation. The histopathological examination for the resected specimen yielded the final diagnosis of welldifferentiated hepatocellular carcinoma. As in this case if there is not enough medical and technical equipment for curative surgery than after the first surgical intervention has been done transporting the patient to a tertiary hospital for curative surgery can be saving life.

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“…Patients with FLC treated with surgical resection have a more favorable outcome than nonfibrolamellar hepatocellular carcinomas with reported 5-year survival ranging from 58% to 82% [1]. Spontaneous rupture of HCC occurs in 3% to 26% of all patients with HCC, and high mortality rate, in the range of 32% to 67%, has been reported [3, 4] The pathogenesis of liver rupture is not well known; several hypotheses have been proposed in the literature, including a fast-growing tumor resulting in central necrosis, coagulopathy, fragility, vascular congestion and venous compression, or infiltration of the tumor [5]. Tumor size >5 cm and extrahepatic invasion have been associated with high propensity to rupture [6–8].…”

Section: Discussionmentioning

confidence: 99%