Page 29 - Read Online
P. 29

Fung et al.                                                                                                                                                            Hepatocellular carcinoma rupture hepatectomy

           Table 2: Post-operative outcomes and long-term follow-up data for post-hepatectomy patients, expressed as
           medians with range
                                               Emergency hepatectomy (n = 9) Interval hepatectomy (n = 21)  P value
            Complications
               Wound infection                             2                        2                 0.35
               Pleural effusion                            2                        3                 0.60
               Pleural effusion requiring drainage         0                        1                 0.51
               Confusion                                   0                        1                 0.12
               Ascites                                     0                        1                 0.51
               Total                                     4 (44%)                  8 (38%)             0.53
            Median hospital stay after hepatectomy (days)  10 (5-17)             12 (6-32)            0.07
            30 day mortality rate                          0                        0                  -
            Time to intra-hepatic recurrence (months)  7.8 (2.6-100)            5.0 (1.1-39.5)        0.12
            Time to extra-hepatic recurrence (months)  6.8 (6.4-8.9)            9.7 (4.0-47.9)        0.59
            Peritoneal recurrence                        1 (11%)                  6 (29%)             0.27
            Time to peritoneal recurrence (months)        6.4                   6.4 (4.0-10.1)        0.55
            Pulmonary recurrence                         3 (33%)                  4 (19%)             0.44
            Time to pulmonary recurrence (months)      6.8 (6.4-8.9)            7.9 (4.0-12.2)        0.06
            Recurrence in other location                   0                      4 (33%)             0.15
            Time to other location recurrence (months)     -                   11.7 (10.1-47.8)
            Time to earliest recurrence (months)          6.8                       5.6               0.74
            Overall survival (months)                   29 (4-100)               15.7 (8-49)          0.25
            1-year overall survival                     7/9 (78%)               18/21 (85%)           0.59
            3-year overall survival                     4/9 (45%)                9/21 (43%)           0.94
            5-year overall survival                     0/9 (0%)                 1/21 (5%)            0.51

            A                                             B




















           Figure 2: (A) Recurrence-free survival after emergency and interval hepatectomy for ruptured hepatocellular carcinoma (P = 0.74, log rank
           test); (B) overall survival after emergency and interval hepatectomy for ruptured hepatocellular carcinoma (P = 0.25, log rank test)


           was longer, but extra-hepatic  recurrence  shorter in   The risk factors for HCC rupture are multifactorial,
           the emergency hepatectomy group. Overall median    and include rapid tumour growth with necrosis, vessel
           survival time was longer in the emergency group (29   erosion or venous thrombosis by tumour cells. [16,21]
           vs. 15.7 months, P = 0.26) but overall 1-, 3- and 5-year   Additionally, left lobe tumours might be more inclined
           survival rates were similar in both groups.        to rupture due to the smaller anatomical span of the
                                                              left lobe. [22]
           DISCUSSION
                                                              Bassi et al. [23]  commented that rupture of HCC which
           Rupture of hepatocellular carcinoma (HCC) is a rare but   were located at the free surfaces of the liver can
           life-threatening complication of HCC, and is associated   result in bleeding  into the peritoneal  cavity due to
           with a high mortality rate (up to 75%) in the acute   the lack of hepatic parenchyma covering the tumour.
           phase due to  a  combination of  hypovolemic shock,   Kanematsu  et al. [24]  showed that tumour protrusion
           coagulopathy and subsequent hepatic failure. [19,20]    was a risk factor for its subsequent rupture, whereas

            200                                                                                                     Hepatoma Research ¦ Volume 3 ¦ September 08, 2017
   24   25   26   27   28   29   30   31   32   33   34