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 identified 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 related to 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. (C) 2010 Baishideng. All rights reserved.