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Yan J, Li T, Deng M, Fan H. Ruptured Hepatocellular Carcinoma: What Do Interventional Radiologists Need to Know? Front Oncol 2022; 12:927123. [PMID: 35785181 PMCID: PMC9243354 DOI: 10.3389/fonc.2022.927123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 05/16/2022] [Indexed: 11/13/2022] Open
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.
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Affiliation(s)
- Jingxin Yan
- Department of Interventional Therapy, Affiliated Hospital of Qinghai University, Xining, China
- Department of Postgraduate, Qinghai University, Xining, China
- *Correspondence: Jingxin Yan, ; Haining Fan,
| | - Ting Li
- Department of Orthopedics, Sichuan Provincial People’s Hospital, Chengdu, China
- Department of Postgraduate, Chengdu Medical College, Chengdu, China
| | - Manjun Deng
- Department of Hepatopancreatobiliary Surgery, Affiliated Hospital of Qinghai University, Xining, China
- Qinghai Province Key Laboratory of Hydatid Disease Research, Xining, China
| | - Haining Fan
- Department of Hepatopancreatobiliary Surgery, Affiliated Hospital of Qinghai University, Xining, China
- Qinghai Province Key Laboratory of Hydatid Disease Research, Xining, China
- *Correspondence: Jingxin Yan, ; Haining Fan,
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Yan J, Li T, Deng M, Fan H. Ruptured Hepatocellular Carcinoma: What Do Interventional Radiologists Need to Know? Front Oncol 2022. [DOI: 10.3389/fonc.2022.927123\] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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.
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Xia F, Ndhlovu E, Zhang M, Chen X, Zhang B, Zhu P. Ruptured Hepatocellular Carcinoma: Current Status of Research. Front Oncol 2022; 12:848903. [PMID: 35252016 PMCID: PMC8891602 DOI: 10.3389/fonc.2022.848903] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 01/28/2022] [Indexed: 12/13/2022] Open
Abstract
Background Ruptured hepatocellular carcinoma (rHCC) is considered a rare and life-threatening manifestation; when it happens, it often requires acute and positive intervention. At present, the mechanism of rHCC development is gradually being understood while there are many kinds of rHCC treatment. From our clinical observation, the prognosis of rHCC patients is not as poor as it is currently believed. It may not be appropriate to include all patients with rHCC in T4. Main Body The incidence of ruptured hepatocellular carcinoma is now rising. Especially in the Asian region, it can even reach 10% – 15%. The most common symptom of HCC rupture is abdominal pain, and there are now a variety of treatments for hepatocellular carcinoma rupture. With aggressive treatment, rHCC patients can also achieve a better prognosis. The patient’s condition varies on admission, so the treatment methods will also be different. It is critical to identify prognostic factors simultaneously, and rHCC can be effectively managed by focusing on important prognostic factors. Conclusion A review was carried out to analyze diagnosis, mechanism, treatment, and prognostic risk factors on this disease condition during the current situation; it is hoped that it will provide better guidance for clinicians. Moreover, patients with rHCC were managed hierarchically to prolong their prognosis.
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Affiliation(s)
- Feng Xia
- Department of Hepatic Surgery Center, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Elijah Ndhlovu
- Department of Hepatic Surgery Center, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Mingyu Zhang
- Department of Digestive Medicine. Tongji Hospital of Tongji Medical College in Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoping Chen
- Department of Hepatic Surgery Center, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Bixiang Zhang
- Department of Hepatic Surgery Center, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Peng Zhu
- Department of Hepatic Surgery Center, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Peng Zhu,
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Zhou C, Zu QQ, Liu XL, Wang B, Zhou CG, Shi HB, Liu S. Treatment strategies and prognosis for initially unresectable ruptured hepatocellular carcinoma: a single-center experience in 94 patients. ACTA ACUST UNITED AC 2021; 26:223-229. [PMID: 32209506 DOI: 10.5152/dir.2019.19049] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE To identify the treatment options and prognostic factors for patients with initially unresectable ruptured hepatocellular carcinoma (HCC). METHODS Between June 2012 to December 2016, 94 consecutive patients with initially unresectable ruptured HCC were analyzed retrospectively in this study. Patients were followed until December 2017. Predictors of short-term (≤30 days) and long-term (>30 days) survival were identified by using logistic regression model and Cox proportional hazard model, respectively. RESULTS Of the 94 patients, initial hemostasis treatment was achieved by transarterial embolization (TAE) in 59 patients, surgical hemostasis in 14, and conservative treatment in 21. Twenty-five (26.6%) patients died within 30 d after tumor rupture. In the multivariate analysis, patients treated with aggressive initial treatment strategies (TAE or surgical hemostasis) (P < 0.001) or those with better Child-Pugh class (P = 0.003) and absence of shock on admission (P = 0.001) had a better chance of short-term survival. Of the 69 patients who survived more than 30 days after initial treatment, the median survival time was 268 d. In the multivariate analysis, among the 69 who survived, early modified LCSGJ stage (P = 0.003) and staged hepatectomy as definitive treatment (P < 0.001) were significant predictors of increased long-term survival. CONCLUSION Short-term survival of patients with initially unresectable ruptured HCC could achieve with better Child-Pugh class, absence of shock and aggressive initial treatment strategies. After survived the emergency phase of tumor rupture, long-term survival was significantly increased with early modified LCSGJ stage and staged hepatectomy therapy.
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Affiliation(s)
- Chun Zhou
- Department of Interventional Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qing-Quan Zu
- Department of Interventional Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xing-Long Liu
- Department of Interventional Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Bin Wang
- Department of Interventional Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Chun-Gao Zhou
- Department of Interventional Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hai-Bin Shi
- Department of Interventional Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Sheng Liu
- Department of Interventional Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Zhou C, Zhang C, Zu QQ, Wang B, Zhou CG, Shi HB, Liu S. Emergency transarterial embolization followed by staged hepatectomy versus emergency hepatectomy for ruptured hepatocellular carcinoma: a single-center, propensity score matched analysis. Jpn J Radiol 2020; 38:1090-1098. [PMID: 32564291 DOI: 10.1007/s11604-020-01007-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 06/14/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To compare the feasibility and efficacy of emergency transarterial embolization (TAE) followed by staged hepatectomy (SH) with emergency hepatectomy (EH) for ruptured hepatocellular carcinoma (HCC). METHODS Between January 2012 and December 2017, 102 patients with HCC rupture received EH or emergency TAE followed by SH in our center. Patients were followed until April 2019. Propensity score matching (PSM) analysis was used at a 1:2 ratio, resulting in 20 patients in the SH group and 40 patients in the EH group. We retrospectively compared the operative variables, recurrence status, disease-free survival (DFS), and overall survival (OS) of patients between the two matched groups. RESULTS Compared with the matched EH group, the SH group showed significantly decreased perioperative blood loss or blood transfusion, shortened intraoperative duration of clamping and postoperative hospital stay (P < 0.05), while achieving comparable long-term OS (SH group: 39.0 months vs. EH group: 38.1 months, P = 0.342). There was no significant difference in the peritoneal metastasis rate (SH group: 20.0% vs. EH group: 25.6%, P = 0.874), recurrence rate (SH group: 65.0% vs. EH group: 71.8%, P = 0.333) or DFS (SH group: 9.4 months vs. EH group: 7.7 months, P = 0.602) between the two matched groups. CONCLUSION For resectable ruptured HCC, emergency TAE of rupture which followed by SH, could bring patients about intraoperative and postoperative benefits when compared to EH. Moreover, this combination treatment will not increase the rate of peritoneal metastasis or recurrence, and might achieve favorable survival benefits for patients.
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Affiliation(s)
- Chun Zhou
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing, 210029, China
| | - Chu Zhang
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing, 210029, China
| | - Qing-Quan Zu
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing, 210029, China
| | - Bin Wang
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing, 210029, China
| | - Chun-Gao Zhou
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing, 210029, China
| | - Hai-Bin Shi
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing, 210029, China
| | - Sheng Liu
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing, 210029, China.
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Lee HS, Choi GH, Choi JS, Han KH, Ahn SH, Kim DY, Park JY, Kim SU, Kim SH, Yoon DS, Kim JK, Choi JW, Kim SS, Park H. Staged partial hepatectomy versus transarterial chemoembolization for the treatment of spontaneous hepatocellular carcinoma rupture: a multicenter analysis in Korea. Ann Surg Treat Res 2019; 96:275-282. [PMID: 31183331 PMCID: PMC6543054 DOI: 10.4174/astr.2019.96.6.275] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 03/16/2019] [Accepted: 04/01/2019] [Indexed: 02/07/2023] Open
Abstract
Purpose The aim of this study was to identify the prognostic factors and compare the long-term outcomes of staged hepatectomy and transarterial chemoembolization (TACE) for patients with spontaneous rupture of hepatocellular carcinoma (HCC). Methods This study is a multicenter, retrospective analysis of patients with newly diagnosed ruptured HCC. To compare overall survival between staged hepatectomy group and TACE alone group, we performed propensity score-matching to adjust for significant differences in patient characteristics. To identify prognostic factors, the clinical characteristics at the time of diagnosis of tumor rupture were investigated using Cox-regression analysis. Results From 2000 to 2014, 172 consecutive patients with newly diagnosed ruptured HCC were treated in 6 Korean centers. One hundred seventeen patients with Child-Pugh class A disease were identified; of which 112 were initially treated with transcatheter arterial embolization (TAE) for hemostasis and five underwent emergency surgery for bleeder ligation. Of the 112 patients treated with TAE, 44 underwent staged hepatectomy, 61 received TACE alone, and 7 received conservative treatment after TAE. Those that underwent staged hepatectomy had significantly higher overall survival than those that underwent TACE alone before matching (P < 0.001) and after propensity score-matching (P = 0.006). Multivariate analysis showed that type of treatment, presence of portal vein thrombosis, pretreatment transfusion >1,200 mL, and tumor size >5 cm were associated with poor overall survival. Conclusion Staged hepatectomy may offer better long-term survival than TACE alone for spontaneous rupture of HCC. Staged hepatectomy should be considered in spontaneous rupture of HCC with resectable tumor and preserved liver function.
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Affiliation(s)
- Hyung Soon Lee
- Department of Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Gi Hong Choi
- Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Sub Choi
- Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kwang-Hyub Han
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Hoon Ahn
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Do Young Kim
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jun Yong Park
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Up Kim
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Hoon Kim
- Department of Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Dong Sup Yoon
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Keun Kim
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Won Choi
- Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Soon Sun Kim
- Department of Internal Medicine, Ajou University Medical Center, Ajou University School of Medicine, Suwon, Korea
| | - Hana Park
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
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Lee KH, Tse MLD, Law M, Cheng AKC, Wong HYF, Yu ML, Li YL, Ho YC, Chu F, Lam WWM. Development and validation of an imaging and clinical scoring system to predict early mortality in spontaneous ruptured hepatocellular carcinoma treated with transarterial embolization. Abdom Radiol (NY) 2019; 44:903-911. [PMID: 30631903 DOI: 10.1007/s00261-019-01895-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE To develop and validate a scoring system using a combination of imaging and clinical parameters to predict 30-day mortality in ruptured HCC (rHCC) patients after transarterial embolization (TAE). METHODS 98 consecutive patients with rHCC who underwent abdominal CT and subsequent TAE between January 2007 and December 2016 were retrospectively reviewed. The CT scans were reviewed by two radiologists blinded to the patient outcome. Clinical parameters including serum bilirubin, albumin, INR, creatinine, and hemoglobin were recorded. Independent risk factors for 30-day mortality after TAE were identified using multivariate binary logistic regression, for development of a scoring system. The scoring system was then validated in 20 patients between January 2017 and May 2018. RESULTS In the development cohort, bilobar tumor distribution (OR = 29.6), clinical parameters of bilirubin > 2.5 mg/dL (OR = 5.9), and albumin < 30 g/L (OR = 4.1) were independent predictors for 30-day mortality. A 6-point score was derived and yielded area-under-the-receiver-operating-characteristic-curve (AUC) of 0.904. A score ≥ 4 resulted in sensitivity of 80.5% and specificity of 91.2% for 30-day mortality. In the validation cohort, AUC for 30-day mortality was 0.939. A score ≥ 4 resulted in sensitivity of 81.2% and specificity of 88.9%. In both development and validation cohorts, the proposed scoring system was better than biochemical components of Child-Pugh score and serum bilirubin to predict 30-day mortality. CONCLUSION Imaging and clinical parameters can be combined into a scoring system to accurately predict 30-day mortality after TAE in rHCC patients. The score may help identify and counsel high-risk patients.
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Affiliation(s)
- Kam-Ho Lee
- Department of Radiology, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, HKSAR, China.
| | - Man-Lap Donald Tse
- Department of Radiology, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, HKSAR, China
| | - Martin Law
- Department of Radiology, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, HKSAR, China
| | - Andrew Kai-Chun Cheng
- Department of Radiology, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, HKSAR, China
| | - Ho-Yuen Frank Wong
- Department of Radiology, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, HKSAR, China
| | - Man-Leung Yu
- Department of Radiology, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, HKSAR, China
| | - Yan-Lin Li
- Department of Radiology, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, HKSAR, China
| | - Yuen-Chi Ho
- Department of Radiology, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, HKSAR, China
| | - Ferdinand Chu
- Department of Radiology, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, HKSAR, China
| | - Wendy Wai-Man Lam
- Department of Radiology, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, HKSAR, China
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Moris D, Chakedis J, Sun SH, Spolverato G, Tsilimigras DI, Ntanasis-Stathopoulos I, Spartalis E, Pawlik TM. Management, outcomes, and prognostic factors of ruptured hepatocellular carcinoma: A systematic review. J Surg Oncol 2017; 117:341-353. [DOI: 10.1002/jso.24869] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 09/12/2017] [Indexed: 12/15/2022]
Affiliation(s)
- Demetrios Moris
- Department of Surgery; The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute; Columbus Ohio
| | - Jeffery Chakedis
- Department of Surgery; The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute; Columbus Ohio
| | - Steven H. Sun
- Department of Surgery; The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute; Columbus Ohio
| | - Gaya Spolverato
- Department of Surgery; The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute; Columbus Ohio
| | - Diamantis I. Tsilimigras
- Department of Therapeutics; Alexandra General Hospital; National and Kapodistrian University of Athens; Athens Greece
| | - Ioannis Ntanasis-Stathopoulos
- Department of Therapeutics; Alexandra General Hospital; National and Kapodistrian University of Athens; Athens Greece
| | - Eleftherios Spartalis
- Laboratory of Experimental Surgery and Surgical Research; National and Kapodistrian University of Athens; Athens Greece
| | - Timothy M. Pawlik
- Department of Surgery; The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute; Columbus Ohio
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Bertacco A, D'Amico F, Romano M, Finotti M, Vitale A, Cillo U. Liver radiofrequency ablation as emergency treatment for a ruptured hepatocellular carcinoma: a case report. J Med Case Rep 2017; 11:54. [PMID: 28245861 PMCID: PMC5331708 DOI: 10.1186/s13256-017-1199-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 01/03/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Hemoperitoneum is a possible complication of hepatocellular carcinoma that may require emergency surgery as an alternative to radiological locoregional therapies. CASE PRESENTATION We present a case report of a 78-year-old white man with alcoholic-related cirrhosis and a multifocal hepatocellular carcinoma. An abdominal computed tomography scan showed multiple and bilateral foci of bleeding from broken liver cancer. He was urgently transferred from our radiology unit to our operating room for massive hemoperitoneum. A middle line laparotomy detected a massive hemoperitoneum. His liver was cirrhotic and completely subverted by a tumor; there were two spontaneous bleeding lacerations on segments II and IV, which were uncontrollable with conventional hemostatic techniques. Therefore, it was decided to carry out the coagulation of the multiple vascular afferents of each single mass by means of radiofrequency ablation cycles performed circumferentially on both nodules for a total of 40 minutes. Hemostasis was achieved; the radiofrequency ablation controlled the bleeding from his ruptured hepatocellular carcinoma. He was transferred to our intensive care unit for postoperative monitoring in terms of hemodynamic stability. On postoperative day 2 he was discharged from our intensive care unit. CONCLUSIONS Multifocal bleeding hepatocellular carcinoma still has an extremely high mortality. The angiographic control of multiple bilateral bleeding lesions can be extremely difficult and can be contraindicated by the location of the lesions and by the overall clinical condition of the patient. In this case, treatment with radiofrequency ablation has proven to be effective in the control of multiple and bilateral hepatic lesions. This particular technique allowed us to attack the lesion at the level of the vascular pedicle in order to control the bleeding.
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Affiliation(s)
- Alessandra Bertacco
- Department of Surgery, Oncology and Gastroenterology (DISCOG), Hepatobiliary Surgery and Liver Transplantation, Padua University, Padua, Italy.,Department of Surgery, Division of Transplantation and Immunology, Yale University, New Haven, Connecticut, USA
| | - Francesco D'Amico
- Department of Surgery, Oncology and Gastroenterology (DISCOG), Hepatobiliary Surgery and Liver Transplantation, Padua University, Padua, Italy. .,Department of Surgery, Division of Transplantation and Immunology, Yale University, New Haven, Connecticut, USA.
| | - Maurizio Romano
- Department of Surgery, Oncology and Gastroenterology (DISCOG), Hepatobiliary Surgery and Liver Transplantation, Padua University, Padua, Italy
| | - Michele Finotti
- Department of Surgery, Oncology and Gastroenterology (DISCOG), Hepatobiliary Surgery and Liver Transplantation, Padua University, Padua, Italy
| | - Alessandro Vitale
- Department of Surgery, Oncology and Gastroenterology (DISCOG), Hepatobiliary Surgery and Liver Transplantation, Padua University, Padua, Italy
| | - Umberto Cillo
- Department of Surgery, Oncology and Gastroenterology (DISCOG), Hepatobiliary Surgery and Liver Transplantation, Padua University, Padua, Italy
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