Management of Spontaneously Ruptured Hepatocellular Carcinoma and Hemoperitoneum Manifested as Acute Abdomen in the Emergency Room
- 3 August 2012
- journal article
- research article
- Published by Wiley in World Journal of Surgery
- Vol. 36 (11), 2670-2676
- https://doi.org/10.1007/s00268-012-1734-6
Abstract
Background Spontaneously ruptured hepatocellular carcinoma (HCC) with hemoperitoneum has a poor prognosis, especially in cases of cirrhosis. Patients usually present to emergency rooms (ERs) with acute abdomen. The aim of the present study was to determine the factors affecting mortality and to compare the prognosis of conservative treatment, transcatheter arterial embolization (TAE), or hepatectomy in these situations. Methods Fifty-four patients with spontaneously ruptured HCC diagnosed between January 2004 and August 2010 were enrolled in this retrospective review of clinical data. Grouping by survival or mortality, univariate and multivariate analyses of factors affecting 30-day mortality, and long-term survival were conducted. The outcomes of the various treatments were analyzed. Results After primary fluid resuscitation in the ER, 6 of 54 patients underwent conservative treatment. Emergency hepatectomy was performed on 19 patients; TAE was used for 29 patients, 18 of whom received staged hepatectomy thereafter. Poor liver function, prolonged international normalized ratio (INR), and conservative treatment were associated with increased 30-day mortality. Logistic regression analysis of cumulative survival revealed that INR ≥ 1.4, multiple intrahepatic HCC, and conservative treatment were related to poorer long-term survival. The patients who received hepatectomy, either immediate or staged after TAE, had higher survival rates of 85.2 % at 30 days and 62.2 % at 1 year. Conclusions The treatment of ruptured HCC should be tailored to the individual case. Prolonged survival is possible in patients with preserved liver function through curative liver resection. Emergency physicians, radiologists, and surgeons play essential roles in managing these patients.Keywords
This publication has 32 references indexed in Scilit:
- Management of ruptured hepatocellular carcinoma: Implications for therapyWorld Journal of Gastroenterology, 2010
- Outcomes and factors influencing survival in cirrhotic cases with spontaneous rupture of hepatocellular carcinoma: a multicenter studyBMC Gastroenterology, 2009
- A simple, noninvasively determined index predicting hepatic failure following liver resection for hepatocellular carcinomaJournal of Hepato-Biliary-Pancreatic Surgery, 2008
- FACTORS AFFECTING EARLY MORTALITY IN SPONTANEOUS RUPTURE OF HEPATOCELLULAR CARCINOMAAnz Journal of Surgery, 2006
- Spontaneous rupture of hepatocelluar carcinoma: surgical resection and long-term survivalEuropean Journal of Surgical Oncology, 2000
- Staged hepatectomy after emergency transcatheter arterial embolization for ruptured hepatocellular carcinomaSurgery, 1998
- Spontaneous Rupture of Hepatocellular CarcinomaJournal of Clinical Gastroenterology, 1995
- Emergency liver resection for spontaneous rupture of hepatocellular carcinoma complicating cirrhosisBritish Journal of Surgery, 1993
- Ruptured hepatocellular carcinoma evokes risk of implanted metastasesJournal of Surgical Oncology, 1989
- Spontaneous Ruptured Hepatocellular Carcinoma; An Appraisal of Surgical TreatmentAnnals of Surgery, 1989