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Fung et al. Hepatoma Res 2017;3:196-204                              Hepatoma Research
           DOI: 10.20517/2394-5079.2017.23
                                                                                                  www.hrjournal.net
            Topic: Management of Huge and Advanced Hepatocellular Carcinoma                     Open Access

           Outcomes of emergency and interval

           hepatectomy for ruptured resectable

           hepatocellular carcinoma: a single tertiary

           referral centre experience



           Andrew Kai Yip Fung, Charing Ching Ning Chong, Kit Fai Lee, John Wong, Yue Sun Cheung, Anthony Kwong Wai
           Fong, Paul Bo San Lai

           Department of Surgery, the Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong 999077, Hong Kong, China.
           Correspondence to: Dr. Andrew Kai Yip Fung, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong
           Kong 999077, Hong Kong, China. E-mail: andrewfung@surgery.cuhk.edu.hk

           How to cite this article: Fung AKY, Chong CCN, Lee KF, Wong J, Cheung YS, Fong AKW, Lai PBS. Outcomes of emergency and interval
           hepatectomy for ruptured resectable hepatocellular carcinoma: a single tertiary referral centre experience. Hepatoma Res 2017;3:196-204.
                                         ABSTRACT

            Article history:              Aim: The short and long term outcomes of patients who underwent emergency and interval
            Received: 24-05-2017          hepatectomy for ruptured and resectable hepatocellular carcinoma (HCC) were analysed.
            Accepted: 29-08-2017          Methods:  The  data  of  patients with  ruptured  HCC  presenting between  April  2004  and
            Published: 08-09-2017         October 2015 were analysed. Emergency hepatectomy was defined as hepatectomy within 48 h
                                          of the clinico-radiological diagnosis of HCC rupture. Results: Thirty patients underwent
            Key words:                    hepatectomy for ruptured HCC. Nine (30%) patients underwent emergency hepatectomy.
            Hepatocellular carcinoma,     The median age was 56 and 54 years (P = 0.13) with a similar gender distribution. The mean
            rupture,                      HCC size (10.5 vs. 8.3 cm, P = 0.17), total blood loss (3,000 vs. 850 mL, P = 0.002) and total
            hepatectomy                   units of red blood cell transfusion (1.9 vs. 0.5 units, P = 0.27) were greater in the emergency
                                          hepatectomy group. The complication rate was 44% and 38% (P = 0.53), with median length
                                          of hospital stay of 10 and 12 days (P = 0.07) in the emergency and interval hepatectomy
                                          groups, respectively, and no 30-day mortality in both groups. The median overall survival
                                          was 29 and 15.7 months (P = 0.25), with survival rates of 78%, 45%, 0% and 85%, 43%
                                          and 5% at 1, 3 and 5 years in the emergency and interval hepatectomy groups, respectively.
                                          Conclusion: Hepatectomy should be considered for ruptured HCC provided the patient could
                                          tolerate curative resection.

           INTRODUCTION                                       rupture includes increased pressure within the tumour,
                                                              rapid tumour growth or necrosis. This situation might
           Hepatocellular carcinoma (HCC) is the fifth commonest   be exacerbated by the presence of liver cirrhosis with
           malignancy  globally.   Rupture of  HCC is  the  third   concurrent thrombocytopenia and coagulopathy. [5]
                              [1]
           commonest presentation  of this condition, with an
           incidence  of 3-15%  and  an associated  in-hospital   The treatment for ruptured  HCC  is determined  by
           mortality of up to 75%. [2-4]  The pathogenesis of HCC   the haemodynamic  stability  of the patient.  In the
                                                                                                      [6]
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