Spontaneously ruptured hepatocellular carcinoma on non-cirrhotic liver: A prospective case series

• Published in: Gastroenterología y Hepatología (English Edition) 2024-08, Vol.47 (7), p.683-690
• Main Authors: Romero-Gutiérrez, Marta, Pascual, Sonia, Márquez, Laura, Gómez-Rubio, Mariano, Miquel, Mireia, Alarcón, Cristina, Ferrer, Teresa, Aracil, Carles, Horta, Diana, Latorre, Raquel, González Santiago, Jesús, Bernal, Vanesa, Fernández, Cristina, Piqueras, Belén, Gutiérrez, María Luisa, Martín, Ana, Morillas, Julia, Morales, Dalia, Blanco, Sonia, Rendón, Paloma, Chico, Inmaculada, Testillano, Milagros, Delgado, Carolina, Matilla, Ana, Gómez Rodríguez, Rafael
• Format: Article
• Language: English
• Subjects: Carcinoma hepatocelular; Cirrhosis; Cirrosis; Cirugía; Hemoperitoneo; Hemoperitoneum; Hepatocellular carcinoma; Surgery
• ISSN: 2444-3824; 2444-3824
• DOI: 10.1016/j.gastre.2024.04.032

Spontaneous ruptured hepatocellular carcinoma is an uncommon complication, and there are scarce data about non-cirrhotic patients. Tumor treatment is not standardized and the risk of peritoneal dissemination is unclear. Aim: we analyzed the treatment and survival in patients with rHCC on non-cirrhotic liver. One hundred and forty-one non-cirrhotic patients with hepatocellular carcinoma diagnosed by histology were included in a multicenter prospective registry (2018–2022). Seven of them (5%) presented with hemoperitoneum due to spontaneous rupture. Liver disease was associated in three patients (42.9%). A single nodule was detected in three cases (42.9%). One patient had vascular invasion and none extrahepatic spread. Initial hemostatic therapy and sequential treatment was individualized. Patients with single nodule were treated: resection (one case) with recurrence at 4 months treated with TACE and sorafenib. TACE/TAE followed by surgery (two cases) one in remission 43 months later, the other had liver recurrence at 18 months and was transplanted. Patients with multiple lesions were treated: TAE/emergency surgery and subsequent systemic therapy (two cases), one received lenvatinib (1-year survival) and the other sorafenib (5-month survival). TAE and surgery with subsequent systemic therapy (one case). Initial hemostatic surgery, dying on admission (one case). No patient developed intraperitoneal metastasis. All patients with multiple lesions died by tumor. The 3-year survival rate was 42.9%. Initial hemostasis was achieved in all patients by TAE/TACE or surgery. Subsequent treatment was individualized, based on tumor characteristics, regardless of rupture. Long-time remission could be achieved in single nodule patients. El carcinoma hepatocelular (CHC) roto es una complicación infrecuente. El tratamiento del tumor no está estandarizado y el riesgo de diseminación peritoneal es controvertido. Objetivo: analizamos el tratamiento y la supervivencia del CHC roto, sin cirrosis. Del registro prospectivo multicéntrico (23 centros) de pacientes sin cirrosis diagnosticados histológicamente de CHC (2018-2022), 7 de los 141 pacientes incluidos comenzaron con CHC roto (5%). Presentaban hepatopatía crónica 3 (42,9%). En 3 (42,9%) el nódulo era único. Uno presentó invasión macrovascular y ninguno diseminación extrahepática. La terapia hemostática inicial y el tratamiento para el CHC se individualizó. En los pacientes con lesión única: resección (un caso) con recidiva a