Joliat Gaëtan-Romain, Labgaa Ismail, Uldry Emilie, Demartines Nicolas, Halkic Nermin
Department of Visceral Surgery, University Hospital CHUV, Lausanne, Switzerland.
Eur J Gastroenterol Hepatol. 2018 Jul;30(7):792-796. doi: 10.1097/MEG.0000000000001115.
Hepatocellular carcinomas (HCC) can infrequently rupture and cause hemorrhage. Little is known on recurrence rate (RR) and overall survival (OS) in case of ruptured HCC. This study aimed to assess RR, time to recurrence, and OS of operated ruptured HCC.
All operated patients with HCC (1999-2015) were reviewed. Patient demographics, perioperative details, and postoperative outcomes of ruptured HCC were recorded. RR, time to recurrence, and OS were calculated. RR and OS of ruptured and non-ruptured HCC were compared.
Among the 140 consecutive patients with HCC operated during the study period, 14 presented with rupture. Eleven patients had cirrhosis (all Child-Pugh A). At presentation, median α-fetoprotein and hemoglobin levels were 23 µg/l (interquartile range: 5-883) and 127 g/l (118-148), respectively. All but one patient felt abdominal pain, and two were in hemorrhagic shock. Preoperative embolization with staged hepatectomy was performed in seven patients. Five patients were first treated conservatively and then had an elective hepatectomy, whereas two patients had upfront surgery (one packing and one segmentectomy). Major hepatectomy was performed in eight cases. Median intraoperative blood loss was 1000 ml (500-2100). Overall complication rate was 36%. Eight patients presented a recurrence (57%; median time to recurrence: 8 months; interquartile range: 6-19). Median OS was 44 months, and 5-year OS was 41%. The 126 operated patients with non-ruptured HCC had a RR of 59/126 (47%; P=0.576) and a 5-year OS of 61% (P=0.448).
RR between ruptured and non-ruptured HCC were similar. Moreover, HCC rupture did not impair OS compared with HCC without rupture.
肝细胞癌（HCC）偶尔会破裂并导致出血。对于破裂性HCC的复发率（RR）和总生存期（OS）了解甚少。本研究旨在评估手术治疗的破裂性HCC的RR、复发时间和OS。
回顾了1999年至2015年期间所有接受手术治疗的HCC患者。记录患者的人口统计学资料、围手术期细节以及破裂性HCC的术后结局。计算RR、复发时间和OS。比较破裂性和非破裂性HCC的RR和OS。
在研究期间连续接受手术治疗的140例HCC患者中，14例出现破裂。11例患者有肝硬化（均为Child-Pugh A级）。就诊时，甲胎蛋白和血红蛋白水平的中位数分别为23μg/L（四分位间距：5 - 883）和127g/L（118 - 148）。除1例患者外，所有患者均有腹痛，2例处于失血性休克状态。7例患者接受了分期肝切除术前栓塞。5例患者先接受保守治疗，然后进行择期肝切除，而2例患者接受了一期手术（1例填塞术和1例肝段切除术）。8例患者进行了大肝切除术。术中失血中位数为1000ml（500 - 2100）。总体并发症发生率为3%。8例患者出现复发（57%；复发时间中位数：8个月；四分位间距：6 - 19）。OS中位数为44个月，5年OS率为41%。126例接受手术治疗的非破裂性HCC患者的RR为59/126（47%；P = 0.576），5年OS率为61%（P = 0.448）。
破裂性和非破裂性HCC的RR相似。此外，与未破裂的HCC相比，HCC破裂并未损害OS。
