Spontaneous rupture of hepatocellular carcinoma: Optimal timing of partial hepatectomy

Partial hepatectomy has been used to treat patients with resectable hepatocellular carcinoma (HCC) which spontaneously ruptured. It is still controversial as to whether emergency partial hepatectomy (EmPH) should be carried out at the time of rupture, or the patients should initially be managed by o...

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Published in:European journal of surgical oncology 2019-10, Vol.45 (10), p.1887-1894
Main Authors: Wu, Jing-jing, Zhu, Peng, Zhang, Zhan-guo, Zhang, Bi-xiang, Shu, Chang, Mba'nbo-koumpa, Abdoul-aziz, Zhang, Zhi-wei, Huang, Zhi-yong, Zhang, Wan-guang, Lau, Wan Yee, Chen, Xiao-ping
Format: Article
Language:English
Subjects:
Hepatectomy
Hepatocellular carcinoma
Peritoneal metastasis
Propensity score matching
Rupture
Survival
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Summary:Partial hepatectomy has been used to treat patients with resectable hepatocellular carcinoma (HCC) which spontaneously ruptured. It is still controversial as to whether emergency partial hepatectomy (EmPH) should be carried out at the time of rupture, or the patients should initially be managed by operative or non-operative treatment to stop the bleeding, followed by staged early or delayed partial hepatectomy when the patient's condition becomes stable. Consecutive 10-year patients with ruptured HCC managed at our center were included in this study. Patients who underwent partial hepatectomy were further subdivided into the EmPH group, the staged early partial hepatectomy (SEPH) group, and the staged delayed partial hepatectomy (SDPH) group. Univariate and multivariate analyses of factors affecting overall survival(OS) were conducted before and after propensity score matching analyses amongst the included patients. OS, postoperative mortality, recurrence free survival (RFS), and peritoneal metastatic rates were compared. The risk factors of peritoneal metastases were determined using the COX regression analysis. The 130 patients who underwent partial hepatectomy were subdivided into the EmPH group (surgery at the time of rupture, n = 30), the SEPH group (surgery ≤ 8 days of rupture, n = 67), and the SDPH group (surgery > 8 days of rupture, n = 33). The remaining 86 patients underwent non-surgical treatment. Partial hepatectomy was an independent predictor of better OS (HR 2.792, P 
ISSN:0748-7983
1532-2157
DOI:10.1016/j.ejso.2019.02.033