Management of ruptured hepatocellular carcinoma:Implications for therapy

AIM:To assess the treatment and tumor-related variables associated with outcome after treatment of spontaneously ruptured hepatocellular carcinoma (HCC).METHODS: Patients with ruptured HCC were identif ied. The complications, mortality and survival were assessed. The relationship between tumor size and the severity of hemoperitoneum and between tumor size and grade were examined.RESULTS: From January 1993 to January 2008, 556 patients with HCC with or without cirrhosis were evaluated; of which, 16 (2.87%) presented with spontaneous rupture. All but 1 patient had cirrhosis. Twelve patients underwent surgical resection while 4 underwent trans-cutaneous arterial catheter embolization (TAE) (trans-cutaneous arterial embolization). Early mortality (<30 d) was 25% (4 of 16) and was inversely relatedto Child-Pugh score; 3 of the 4 early deaths occurred in patients treated with TAE with 1 of 12 occurring in the resected group. There was no correlation between tumor size and grade or between size and severity of hemoperitoneum.CONCLUSION: Tumor size did not correlate with severity of the hemoperitoneum. There was an inverse relationship between G1-G3 (grade of cellular differentiation) HCC and dimensions.

Is transarterial embolization a valuable treatment option for spontaneous rupture of hepatocellular carcinoma: experience from a tertiary care hospital of South-Asia

Aim:Transarterial embolization(TAE)has been found beneficial in treatment of ruptured Hepatocellular carcinoma(HCC)in earlier studies.So far no data is available from Pakistan.The aim of this study was to evaluate clinicopathological characteristics,outcomes of patients presented with spontaneously ruptured,unresectable HCC treated with or without TAE and to evaluate the factors associated with 30-day mortality.Methods:This was a cross sectional study.Patients≥18 years old,presented with spontaneous rupture of unresectable HCC,were evaluated.The outcome measures were control of bleeding,in-hospital mortality,30-day mortality and factors associated with 30-days mortality.Results:Out of 850 patients,24 patients were diagnosed with spontaneously ruptured HCC.Mean age was 58.29±15.26 years.A total of 11(45.8%)patients were treated conservatively and 13(54.2%)underwent TAE.Control of bleeding due to ruptured HCC was significantly higher for those treated via TAE as compared to those who were treated conservatively(92.3%vs.36.4%,P=0.008).Overall median duration for which the patients remained alive after HCC rupture was longer for TAE group(39 days vs.5 days,P=0.03).In-hospital mortality(30.8% vs.72.7%,P=0.04)and 30-day mortality was also lower in TAE group(38.5%vs.90.9%,P=0.01).Those who underwent TAE had lower risk of mortality then conservative group odds ratio(OR)0.25,95% confidence interval(CI0.07-0.90,P=0.03).Failure to control bleeding was associated with higher 30-day mortality(OR 2.14,95% CI 1.24-3.68,P=0.009).Conclusion:Ruptured HCC is a life threatening complication requiring early diagnosis and treatment.TAE is an effective and well-tolerated treatment in the management of ruptured HCC.