Emergency caudate lobectomy for ruptured hepatocellular carcinoma with multiple primary cancers

Hematogenous metastasis to the colon from hepatocellular carcinoma: A case report

Introduction and importance: Most extrahepatic metastases of hepatocellular carcinoma (HCC) are to the lungs and bones, metastases to the colon are rare. In the present study, we experienced a case of metastasis to the ascending colon during repeated treatment for HCC. Case Presentation: A 63-year-old man was diagnosed with multiple HCCs (T4N0M0 stage IIIB) associated with portal vein invasion. Transcatheter arterial chemoembolization (TACE), transarterial infusion (TAI) and radiofrequency ablation (RFA) were performed, and partial response was achieved, but the main nodule at S6 lesion subsequently recurred to protrude outside of the liver. A partial hepatic S6 resection was performed for local control 1.5 years after the initial treatment. IVR was then performed again, but approximately 8 months after hepatic resection, an abdominal computed toography (CT) showed a mass lesion in the ascending colon. After a total colonoscopy and biopsy, a diagnosis of colorectal metastasis of HCC was made. A right hemicolectomy was performed for local control. The patient had a good post-operative course, but developed liver failure due to rapid growth of the tumor thrombus of the main portal vein and died of primary disease approximately 3.5 months after the colon resection. Clinical Discussion: The metastasis of HCC to the colon is an extremely rare occurrence. Conclusion: One possible reason for this rarity is that portal vein tumor thrombosis (PVTT) results in colorectal metastasis via trans-portal retrograde metastasis.

Hepatocellular Carcinoma with Gastrointestinal Involvement: A Systematic Review

In this paper, we aimed to evaluate clinical and imagistic features, and also to provide a diagnostic algorithm for patients presenting with gastrointestinal involvement from hepatocellular carcinoma (HCC). We conducted a systematic search on the PubMed, Scopus and Web of Science databases to identify and collect papers oncases of HCC with gastrointestinal involvement. This search was last updated on 29 April 2022. One hundred and twenty-three articles were included, corresponding to 197 patients. The majority of the patients were male (87.30%), with a mean age of 61.21 years old. The analysis showed large HCCs located mainly in the right hepatic lobe, and highly elevated alfa-fetoprotein (mean = 15,366.18 ng/mL). The most frequent etiological factor was hepatitis B virus (38.57%). Portal vein thrombosis was present in 27.91% of cases. HCC was previously treated in most cases by transarterial chemoembolization (32.99%) and surgical resection (28.93%). Gastrointestinal lesions, developed mainly through direct invasion and hematogenous routes, were predominantly detected in the stomach and duodenum in equal measure—27.91%. Gastrointestinal bleeding was the most common presentation (49.74%). The main diagnostic tools were esophagogastroduodenoscopy (EGD) and computed tomography. The mean survival time was 7.30 months. Gastrointestinal involvement in HCC should be included in the differential diagnosis of patients with underlying HCC and gastrointestinal manifestations or pathological findings in EGD.

Peritoneal metastasis after emergency hepatectomy and delayed hepatectomy for spontaneous rupture of hepatocellular carcinoma

BACKGROUND AND OBJECTIVES

Delayed hepatectomy is the preferred approach for spontaneous rupture of resectable hepatocellular carcinoma (HCC). However, delayed surgery for ruptured HCC may increase the risk of peritoneal metastasis.

METHODS

A retrospective analysis was conducted on the pooled data obtained from 44 HCC patients with spontaneously ruptured hemorrhage, These patients were divided into emergency group and delayed group. Perioperative events, overall survival (OS) and disease-free survival (DFS) rates, and the incidence of recurrent and metastatic disease were compared between these two groups.

RESULTS

Median survival time was 17.0 months in the emergency group vs. 28.0 months in the delayed group. In the emergency group, the 6-month, 1-year and 3-year OS rates were 58.8%, 57.6% and 11.5%. In the delayed hepatectomy group, the 6-month, 1-year and 3-year OS rates of were 84.3%, 77.5% and 37.8%. The incidence of peritoneal metastasis was higher in delayed group than in the emergency group, but the difference was not statistically significant (40.7% vs. 35.3%, P > 0.05).

CONCLUSION

Delayed hepatectomy warrants better short-term prognosis, compared with emergency hepatectomy, for HCC patients with spontaneously ruptured hemorrhage. Delayed hepatectomy does not increase the possibility of postoperative peritoneal metastasis.

Risk factor analysis of perioperative mortality after ruptured bleeding in hepatocellular carcinoma

AIM: To discuss strategies and prognosis for the emergency treatment of ruptured bleeding in primary hepatocellular carcinoma.

METHODS: The retrospective analysis was performed by examining the emergency treatment experiences of 60 cases of ruptured bleeding in primary hepatocellular carcinoma. The treatment methods included surgical tumour resection, transcatheter arterial embolization (TAE) and non-surgical treatment. Univariate and multivariate analyses were performed to identify the risk factors that impacted 30-d mortality in the research groups.

RESULTS: The 30-d mortality of all patients was 28.3% (n = 17). The univariate analysis showed that Child-Pugh C level liver function, shock, massive blood transfusion and large tumour volume were risk factors that influenced 30-d mortality. The multivariate analysis showed that shock and massive blood transfusion were independent risk factors that impacted the 30-d mortality of surgical resection. As for the TAE patients, larger tumour volume was a risk factor towards prognosis.

CONCLUSION: Radical resection and TAE therapy would achieve better results in carefully selected ruptured hepatocellular tumours.