Background/Aims Many recent studies have shown excellent outcomes of surgical resection
for ruptured hepatocellular carcinoma (HCC). In addition, there are several reports suggesting
that a ruptured HCC did not increase the risk for peritoneal dissemination of a tumor after
surgical resection. However, the impact of HCC rupture on recurrence and patient survival has
not yet been clarified.
Methods The medical data of patients who underwent surgical resection for ruptured HCC
in our center between January 2011 and December 2015 were retrospectively reviewed. The
outcomes of the patients were investigated.
Results Among 128 patients who underwent surgical resection for HCC, 5 patients (3.9%) had
a ruptured HCC. All patients underwent elective operation in a stable condition. Transarterial
chemoembolization (TACE) was performed for achieving hemostasis in four patients except
one who achieved spontaneous hemostasis. Two patients had tumor recurrence and one
patient died due to HCC recurrence during the median follow-up duration of 28.3 months
(range, 24.3–62.3 months). One patient who developed late intrahepatic recurrence at 40.0
months after resection was managed well by means of radiofrequency ablation and TACE and
is now alive for 5 years without any evidence of viable tumor. However, the other patient who
showed early peritoneal seeding at 1.9 months after resection finally died despite aggressive
treatments.
Conclusions Rupture of HCC might result in peritoneal seeding of the tumor in the early
postoperative stage, which could lead to a poor result. Nonetheless, surgical resection may be
the best treatment option yielding good survival, even for a ruptured HCC.
Citations
Citations to this article as recorded by
Ruptured Massive Hepatocellular Carcinoma Cured by Transarterial Chemoembolization Ji Eun Lee, Joong-Won Park, In Joon Lee, Bo Hyun Kim, Seoung Hoon Kim, Hyun Beom Kim Journal of Liver Cancer.2020; 20(2): 154. CrossRef
Hepatocellular carcinoma (HCC) is one of the cancers with poor prognosis. However, surgical
resection is the treatment of choice as curative aim for early HCC with preserved liver function.
A 5 year survival rate after curative resection is over 50%. We experienced a case of rapidly
recurred HCC with bone metastasis after surgical resection. In our case, microscopically
microvessel invasion was present after resection. Microvascular invasion (MVI) is an important
factor to influence survival and/or HCC recurrence. So we suggested the patients with MVI
need to follow up intensively and adjuvant therapy may be considered.
The effort we are trying to set up the treatment guideline for hepatocellular carcinoma has produced various guidelines after
drawing a conclusion from Barcelona EASL meeting in 2000. Especially in Korea, the Korean Liver Cancer Study Group
and the National Cancer Center have collaborated on making treatment guideline for hepatocellular carcinoma in the early
stage of setting up the guideline, 2003, and it was a great help to treatment, study and education. However, a need of
revision had been raised due to many changes in the latest treatments and an accumulation of international and domestic
experience. After the proposal of amending the treatment guideline for Hepatocellular carcinoma in the Cancer Control Forum
of the National Cancer Control Planning Board on October 17th, 2008, “2009 Guideline” has been reported in the Conference
of the Korean Liver Cancer Study Group held on June 27th, 2009. When revising the guideline, there are some suggestions
of continuous modification to reflect evidence based medical knowledge, and recently there are some debates about the drawback
of the surgical field which was not handled in EASL and AASLD Guidelines. Therefore, it will broaden your understanding
of liver surgical resection and liver transplantation and it will also be a place for the discussion of disputable issues.