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Nimitrungtawee N, Phinyo P, Chalidapong P, Inmutto N. Comparative analysis among therapeutic modalities in ruptured hepatocellular carcinoma and identification of imaging predictors for survival. BMC Cancer 2024; 24:1045. [PMID: 39183268 PMCID: PMC11346290 DOI: 10.1186/s12885-024-12829-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 08/20/2024] [Indexed: 08/27/2024] Open
Abstract
BACKGROUND Spontaneous rupture of hepatocellular carcinoma (rHCC) poses a life-threatening complication with a mortality rate of 25-75%. Treatment aims at achieving hemostasis and includes options such as trans-arterial embolization, perihepatic packing, and hepatic resection. The optimal treatment remains a subject of debate. Our retrospective review evaluates these treatments and investigates imaging's role in prognosis for rHCC patients. PURPOSE We aimed to compare survival outcomes among rHCC patients who received transarterial embolization (TAE), surgery (perihepatic packing, hepatectomy), or best supportive care (BSC), while also identifying predictive imaging factors in these patients. MATERIALS AND METHODS All patients diagnosed with rHCC and admitted to Maharaj Nakorn Chiangmai Hospital between January 2012 and December 2021 were included. We reviewed clinical features, imaging results, treatment modalities, and outcomes. In order to balance pretreatment confounders, inverse probability treatment weighting (IPTW) was employed. Flexible parametric survival regression was utilized to compare survival outcomes and identify imaging factors predicting the survival of rHCC patients. Hazard ratios (HR) and the difference in restricted mean survival time (RMST) were reported. RESULT Among the 186 rHCC patients included, we observed 90-day and 1-year mortality rates of 64% and 84%, respectively. Both the TAE and surgery groups exhibited significantly lower 1-year mortality rates compared to BSC. The HR were 0.56 (95% CI 0.33-0.96) for TAE and 0.52 (95% CI 0.28-0.95) for surgery compared to BSC. Both the TAE and surgery also significantly extended the 1-yeaar life expectancy post-initial treatment when compared to BSC, with an RMST difference of + 55.40 days (95% CI 30.18-80.63) for TAE vs. BSC and + 68.43 days (95% CI 38.77-98.09) for surgery vs. BSC. The presence of active contrast extravasation and bleeding in both lobes were independent prognostic factors for 1-year survival. CONCLUSIONS TAE and surgical treatments provide comparable survival benefits for rHCC patients, extending survival time by approximately 2 months compared to best supportive care. We strongly recommend active management for all rHCC patients whenever possible.
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Affiliation(s)
- Natthaphong Nimitrungtawee
- Department of Radiology, Diagnostic Radiology Unit, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Phichayut Phinyo
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
- Musculoskeletal Science and Translational Research (MSTR), Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Piemkamol Chalidapong
- Department of Radiology, Diagnostic Radiology Unit, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nakarin Inmutto
- Department of Radiology, Diagnostic Radiology Unit, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
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Aziz H, Kwon YIC, Park A, Kwon Y, Aswani Y, Pawlik TM. Comprehensive review of clinical presentation, diagnosis, management, and prognosis of ruptured hepatocellular carcinoma. J Gastrointest Surg 2024; 28:1357-1369. [PMID: 38759880 DOI: 10.1016/j.gassur.2024.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 05/10/2024] [Accepted: 05/13/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND Spontaneous rupture of hepatocellular carcinoma (rHCC) is a life-threatening complication that occurs in 3 % to 15 % of patients with hepatocellular carcinoma (HCC). This review aimed to discuss the most recent updates in the epidemiology, pathophysiology, risk factors, diagnosis as well as presentation, management, and prognostic factors of rHCC. METHODS A comprehensive systematic review was conducted using Medline/PubMed and Web of Science databases with the end of search date being December 1, 2023 regarding rHCC diagnosis, imaging, and management. RESULTS Achieving adequate hemostasis and stabilization of the patient remains the primary objective in the management of patients with rHCC. In earlier studies, the mortality rate in the acute phase of rHCC was reported to be 25 % to 75 %. However, more recent studies have demonstrated that transcatheter arterial embolization (TAE)/transcatheter arterial chemoembolization (TACE) followed by elective hepatectomy in select patients may offer improved survival benefits and decrease perioperative complications compared with TAE/TACE alone or emergent/1-stage hepatectomy. CONCLUSION Although the prognosis for rHCC remains the worst among causes of death related to HCC, more recent studies have demonstrated that improved short- and long-term patient outcomes may be achieved through active surveillance efforts for HCC combined with advanced multimodal diagnostic tools and multidisciplinary management strategies.
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Affiliation(s)
- Hassan Aziz
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | | | - Andrew Park
- Virginia Commonwealth University School of Medicine, Richmond, VA, United States
| | - Yeseo Kwon
- Tufts University School of Medicine, Boston, MA, United States
| | - Yashant Aswani
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, United States.
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Kaewlai R, Chomchalerm G, Tongsai S, Chatpuwaphat J, Chatkaewpaisal A, Khamman P, Thamtorawat S, Praditsuktavorn B, Maitriwong W, Matsumoto J. Predictors and pathways of in-hospital mortality in active vascular contrast extravasation detected on abdominopelvic CT. Insights Imaging 2024; 15:174. [PMID: 38992307 PMCID: PMC11239638 DOI: 10.1186/s13244-024-01748-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 06/17/2024] [Indexed: 07/13/2024] Open
Abstract
OBJECTIVES This study aimed to identify factors influencing in-hospital mortality in adult patients with active vascular contrast extravasation (AVCE) on abdominopelvic computed tomography (CT). METHODS All consecutive patients with AVCE detected on CT between January 2019 and May 2022 were retrospectively included. Their data were compared through uni- and multivariable analyses between patients with and without in-hospital mortality. Path analysis was utilized to clarify the relationships among factors affecting mortality. RESULTS There were 272 patients (60.2 ± 19.4 years, 150 men) included, of whom 70 experienced in-hospital mortality. Multivariable analysis revealed nonsurgery, chronic kidney disease (CKD) stage 4-5 or dialysis, prolonged partial thromboplastin time (PTT), minimum AVCE length > 8 mm, and a lower rate of packed red cell (PRC) transfusion were identified as independent predictors of in-hospital mortality (p = 0.005-0.048). Path analysis demonstrated direct influences of CKD4-5 or dialysis, prolonged PTT, and minimum AVCE length on mortality (coefficients 0.525-0.616; p = 0.009 to < 0.001). PRC transfusion impacted mortality through nonsurgery (coefficient 0.798, p = 0.003) and intensive care unit (ICU) admission (coefficients 0.025, p = 0.016), leading to subsequent death. Three AVCE spaces (free, loose, and tight) defined on CT were not directly associated with in-hospital mortality. CONCLUSION In adults with AVCE on CT, AVCE size had a direct independent influence on mortality, highlighting the critical role of radiologists in detecting and characterizing this finding. Additionally, CKD4-5 or dialysis and prolonged PTT also directly influenced mortality, while the lower rate of PRC transfusion impacted mortality through nonsurgery and ICU admission. CLINICAL RELEVANCE STATEMENT In patients with active vascular contrast extravasation (AVCE) on abdominopelvic CT, larger AVCE directly increased in-hospital mortality. Radiologists' detection and characterization of this finding is crucial, along with recognizing factors like CKD4-5, dialysis, and prolonged PTT to improve patient outcomes. KEY POINTS Several factors independently predicted in-hospital mortality in patients with abdominopelvic AVCE. Extravasation length > 8 mm was the only imaging marker predictive of in-hospital mortality. Non-imaging factors correlated with in-hospital mortality, and PRC transfusion impacted mortality through nonsurgery and ICU admission pathways.
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Affiliation(s)
- Rathachai Kaewlai
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd, Bangkok Noi, Bangkok, 10700, Thailand.
| | - Gun Chomchalerm
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd, Bangkok Noi, Bangkok, 10700, Thailand
| | - Sasima Tongsai
- Department of Research, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd, Bangkok Noi, Bangkok, 10700, Thailand
| | - Jitti Chatpuwaphat
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd, Bangkok Noi, Bangkok, 10700, Thailand
| | - Anchisa Chatkaewpaisal
- Department of Anatomy, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd, Bangkok Noi, Bangkok, 10700, Thailand
| | - Pramuk Khamman
- Department of Anatomy, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd, Bangkok Noi, Bangkok, 10700, Thailand
| | - Somrach Thamtorawat
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd, Bangkok Noi, Bangkok, 10700, Thailand
| | - Banjerd Praditsuktavorn
- Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd, Bangkok Noi, Bangkok, 10700, Thailand
| | - Worapat Maitriwong
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd, Bangkok Noi, Bangkok, 10700, Thailand
| | - Junichi Matsumoto
- Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
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Wang C, Zhong L, Xu J, Zhuang Q, Gong F, Chen X, Tao H, Hu C, Huang F, Yang N, Li J, Zhao Q, Sun X, Huo Y, Chen Q, Zhao Y, Peng R, Liu Z. Oncolytic mineralized bacteria as potent locally administered immunotherapeutics. Nat Biomed Eng 2024; 8:561-578. [PMID: 38514774 DOI: 10.1038/s41551-024-01191-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 02/17/2024] [Indexed: 03/23/2024]
Abstract
Oncolytic bacteria can trigger innate immune activity. However, the antitumour efficacy of inactivated bacteria is poor, and attenuated live bacteria pose substantial safety risks. Here we show that intratumourally injected paraformaldehyde-fixed bacteria coated with manganese dioxide potently activate innate immune activity, modulate the immunosuppressive tumour microenvironment and trigger tumour-specific immune responses and abscopal antitumour responses. A single intratumoural administration of mineralized Salmonella typhimurium suppressed the growth of multiple types of subcutaneous and orthotopic tumours in mice, rabbits and tree shrews and protected the cured animals against tumour rechallenge. We also show that mineralized bacteria can be administered via arterial embolization to treat orthotopic liver cancer in rabbits. Our findings support the further translational testing of oncolytic mineralized bacteria as potent and safe antitumour immunotherapeutics.
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Affiliation(s)
- Chenya Wang
- Institute of Functional Nano & Soft Materials (FUNSOM), Jiangsu Key Laboratory for Carbon-Based Functional Materials and Devices, Soochow University, Suzhou, China
| | - Liping Zhong
- National Center for International Research of Biotargeting Theranostics, Guangxi Key Laboratory of Biotargeting Theranostics, Collaborative Innovation Center for Targeting Tumor Diagnosis and Therapy, Guangxi Medical University, Nanning, China
| | - Jiachen Xu
- Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Qi Zhuang
- Institute of Functional Nano & Soft Materials (FUNSOM), Jiangsu Key Laboratory for Carbon-Based Functional Materials and Devices, Soochow University, Suzhou, China
| | - Fei Gong
- Institute of Functional Nano & Soft Materials (FUNSOM), Jiangsu Key Laboratory for Carbon-Based Functional Materials and Devices, Soochow University, Suzhou, China
| | - Xiaojing Chen
- Institute of Functional Nano & Soft Materials (FUNSOM), Jiangsu Key Laboratory for Carbon-Based Functional Materials and Devices, Soochow University, Suzhou, China
| | - Huiquan Tao
- InnoBM Pharmaceuticals Co. Ltd., Suzhou, China
| | - Cong Hu
- National Center for International Research of Biotargeting Theranostics, Guangxi Key Laboratory of Biotargeting Theranostics, Collaborative Innovation Center for Targeting Tumor Diagnosis and Therapy, Guangxi Medical University, Nanning, China
| | - Fuquan Huang
- National Center for International Research of Biotargeting Theranostics, Guangxi Key Laboratory of Biotargeting Theranostics, Collaborative Innovation Center for Targeting Tumor Diagnosis and Therapy, Guangxi Medical University, Nanning, China
| | - Nailin Yang
- Institute of Functional Nano & Soft Materials (FUNSOM), Jiangsu Key Laboratory for Carbon-Based Functional Materials and Devices, Soochow University, Suzhou, China
| | - Junyan Li
- Institute of Functional Nano & Soft Materials (FUNSOM), Jiangsu Key Laboratory for Carbon-Based Functional Materials and Devices, Soochow University, Suzhou, China
| | - Qi Zhao
- Institute of Functional Nano & Soft Materials (FUNSOM), Jiangsu Key Laboratory for Carbon-Based Functional Materials and Devices, Soochow University, Suzhou, China
- InnoBM Pharmaceuticals Co. Ltd., Suzhou, China
| | - Xinjun Sun
- National Center for International Research of Biotargeting Theranostics, Guangxi Key Laboratory of Biotargeting Theranostics, Collaborative Innovation Center for Targeting Tumor Diagnosis and Therapy, Guangxi Medical University, Nanning, China
| | - Yu Huo
- National Center for International Research of Biotargeting Theranostics, Guangxi Key Laboratory of Biotargeting Theranostics, Collaborative Innovation Center for Targeting Tumor Diagnosis and Therapy, Guangxi Medical University, Nanning, China
| | - Qian Chen
- Institute of Functional Nano & Soft Materials (FUNSOM), Jiangsu Key Laboratory for Carbon-Based Functional Materials and Devices, Soochow University, Suzhou, China
| | - Yongxiang Zhao
- National Center for International Research of Biotargeting Theranostics, Guangxi Key Laboratory of Biotargeting Theranostics, Collaborative Innovation Center for Targeting Tumor Diagnosis and Therapy, Guangxi Medical University, Nanning, China.
| | - Rui Peng
- Institute of Functional Nano & Soft Materials (FUNSOM), Jiangsu Key Laboratory for Carbon-Based Functional Materials and Devices, Soochow University, Suzhou, China.
| | - Zhuang Liu
- Institute of Functional Nano & Soft Materials (FUNSOM), Jiangsu Key Laboratory for Carbon-Based Functional Materials and Devices, Soochow University, Suzhou, China.
- InnoBM Pharmaceuticals Co. Ltd., Suzhou, China.
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Ji J, Zhou C, Yan LL, Ma Y, Xu C, Wang FA, Zhou WZ, Lv PH. Transarterial Chemoembolization Plus Tyrosinkinase Inhibitors and PD-1 Inhibitors for Spontaneously Ruptured Hepatocellular Carcinoma. Cardiovasc Intervent Radiol 2024; 47:299-309. [PMID: 38291158 DOI: 10.1007/s00270-023-03653-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 12/17/2023] [Indexed: 02/01/2024]
Abstract
PURPOSE To compare the efficacy and safety of transcatheter arterial chemoembolization (TACE) in combination with tyrosinkinase inhibitors (TKI) and PD-1 inhibitors, versus TACE monotherapy for the treatment of ruptured hepatocellular carcinoma (HCC). MATERIALS AND METHODS This study included 104 patients with ruptured HCC receiving either combination therapy or TACE monotherapy at two centers between June 2015 and June 2022. Propensity score matching (PSM) analysis was used at a 1:2 ratio to reduce bias between the two groups. The primary outcome measures were overall survival (OS) and progression-free survival (PFS), and the secondary outcome measures were the occurrence of adverse events (AEs, Common Terminology Criteria for AEs, version 5.0.) and the peritoneal metastasis rate. RESULTS A total of 69 patients were enrolled after PSM, including 23 patients in the combination group and 46 patients in the monotherapy group. The combination group exhibited a significantly longer median OS (553 days, 95% confidence interval [CI] 222.6-883.9) compared to the monotherapy group (105 days, 95% CI 81.2-128.7; P < 0.001). Similarly, the combination group showed a better median PFS (356 days, 95% CI 299.5-412.4) compared to the monotherapy group (97 days, 95% CI 75.9-118.1; P < 0.001). Moreover, there was no significant difference in the peritoneal metastasis rate (combination group: 8.6% vs. monotherapy group: 26.1%, P = 0.119). Grade 3 AEs occurred at a rate of 21.7% and 13% in combination and monotherapy groups, respectively. No Grade 4/5 AEs were observed in either group. CONCLUSIONS Our study demonstrated that the combination of TACE with TKI and PD-1 inhibitors significantly enhances OS and PFS compared to TACE monotherapy in ruptured HCC patients. Furthermore, this combined approach exhibited an acceptable safety profile.
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Affiliation(s)
- Jie Ji
- Department of Interventional Radiology, Northern Jiangsu People's Hospital, 98 West Nantong Road, Yangzhou, 225001, China
| | - Chun Zhou
- Department of Radiology, Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou, Nanjing, 210029, China
| | - Le-le Yan
- Department of Interventional Radiology, Northern Jiangsu People's Hospital, 98 West Nantong Road, Yangzhou, 225001, China
| | - Yuan Ma
- Department of Interventional Radiology, Northern Jiangsu People's Hospital, 98 West Nantong Road, Yangzhou, 225001, China
| | - Chuan Xu
- Department of Interventional Radiology, Northern Jiangsu People's Hospital, 98 West Nantong Road, Yangzhou, 225001, China
| | - Fu-An Wang
- Department of Interventional Radiology, Northern Jiangsu People's Hospital, 98 West Nantong Road, Yangzhou, 225001, China
| | - Wei-Zhong Zhou
- Department of Radiology, Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou, Nanjing, 210029, China
| | - Peng-Hua Lv
- Department of Interventional Radiology, Northern Jiangsu People's Hospital, 98 West Nantong Road, Yangzhou, 225001, China.
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Ni HH, Lu Z, Yang CL, Lv YT, Lu CX, Xiang BD. Clonorchis sinensis on the prognosis of patients with spontaneous rupture of Hepatocellular Carcinoma: An inverse probability of treatment weighting analysis. PLoS Negl Trop Dis 2024; 18:e0011987. [PMID: 38381766 PMCID: PMC10911612 DOI: 10.1371/journal.pntd.0011987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 03/04/2024] [Accepted: 02/12/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND We examined the impact of the Clonorchis sinensis (C. sinensis) infection on the survival outcomes of spontaneous rupture Hepatocellular Carcinoma (srHCC) patients undergoing hepatectomy. METHODS Between May 2013 and December 2021, 157 consecutive srHCC patients who underwent hepatectomy were divided into an no C. sinensis group (n = 126) and C. sinensis group (n = 31). To adjust for differences in preoperative characteristics an inverse probability of treatment weighting (IPTW) analysis was done, using propensity scores. Overall survival (OS) and recurrence-free survival (RFS) were compared before and after IPTW. Multivariate Cox regression analysis was performed to determine whether the C. sinensis infection was an independent prognostic factor after IPTW. RESULTS In original cohort, the no C. sinensis group did not show a survival advantage over the C. sinensis group. After IPTW adjustment, the median OS for the C. sinensis group was 9 months, compared to 29 months for the no C. sinensis group. C. sinensis group have worse OS than no C. sinensis group (p = 0.024), while it did not differ in RFS(p = 0.065). The multivariate Cox regression analysis showed that C. sinensis infection and lower age were associated with worse OS. CONCLUSIONS The C. sinensis infection has an adverse impact on os in srHCC patients who underwent hepatectomy.
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Affiliation(s)
- Hang-Hang Ni
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, People’s Republic of China
- Department of Hepatobiliary Surgery, Zhongshan City People’s Hospital, Zhongshan, People’s Republic of China
| | - Zhan Lu
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, People’s Republic of China
| | - Cheng-Lei Yang
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, People’s Republic of China
| | - Yu-Ting Lv
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, People’s Republic of China
| | - Chun-Xiu Lu
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, People’s Republic of China
| | - Bang-De Xiang
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, People’s Republic of China
- Key Laboratory of Early Prevention and Treatment for Regional High-Frequency Tumors, Ministry of Education, Nanning, People’s Republic of China
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Pan T, Gao F, Huang X, Xu X. Transarterial embolization followed by staged hepatectomy versus emergency hepatectomy for ruptured HCC: a meta-analysis. Clin Transl Oncol 2024; 26:155-170. [PMID: 37328589 DOI: 10.1007/s12094-023-03232-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 05/25/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND To compare the efficacy and safety between emergency hepatectomy (EH) and emergency transarterial embolization (TAE) followed by staged hepatectomy (SH) in the treatment of spontaneous ruptured hepatocellular carcinoma (rHCC). METHODS Databases (PubMed, EMBASE, Web of science, Cochrane Library, ClinicalTrial.gov, CNKI, Wanfang and VIP) were searched for all relevant comparative studies from January 2000 to October 2020. Odds ratio (OR) and mean difference (MD) with 95% confidence interval (CI) were pooled for dichotomous and continuous variables, respectively. Subgroup analyses based on the kind of embolization were conducted. RevMan 5.3 software was adopted for meta-analysis. RESULTS Eighteen studies with 871 patients were finally included in this meta-analysis, 448 in EH group and 423 in TAE + SH group. No significant difference was observed in successful hemostasis (P = 0.42), postoperative hospital stay (P = 0.12), complication rate (P = 0.08) between EH and TAE + SH group. However, TAE + SH group was associated with shorter operating time (P < 0.00001), fewer perioperative blood loss (P = 0.007), fewer blood transfusion (P = 0.003), lower in-hospital mortality (P < 0.00001) and higher 1-year survival as well as 3-year survival (P < 0.0001; P = 0.003) compared with EH group. CONCLUSION Compared with EH, TAE + SH could reduce perioperative operating time, blood loss, blood transfusion, mortality rate and increase the long-term survival rate of the rHCC patients, which may be a better treatment for resectable rHCC.
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Affiliation(s)
- Tianfan Pan
- Department of Interventional Radiology, Jiangyin People's Hospital, 3 Ying Rui Road, Jiangyin, 214400, Jiangsu Province, China
- Nanjing Medical University, Nanjing, 211100, Jiangsu Province, China
| | - Feng Gao
- Department of Interventional Radiology, Jiangyin People's Hospital, 3 Ying Rui Road, Jiangyin, 214400, Jiangsu Province, China
| | - Xiangzhong Huang
- Department of Interventional Radiology, Jiangyin People's Hospital, 3 Ying Rui Road, Jiangyin, 214400, Jiangsu Province, China.
| | - Xinjian Xu
- Department of Interventional Radiology, Jiangyin People's Hospital, 3 Ying Rui Road, Jiangyin, 214400, Jiangsu Province, China.
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Lv TR, Liu F, Jin YW, Hu HJ, Ma WJ, Li FY. Meta-analysis of Prognostic Factors for Overall Survival Among Resected Patients with Spontaneous Ruptured Hepatocellular Carcinoma. J Gastrointest Surg 2023; 27:2983-3000. [PMID: 37932594 DOI: 10.1007/s11605-023-05860-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 09/29/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVE Our meta-analysis was performed to explore the prognostic factors for overall survival among post-hepatectomy patients with spontaneous ruptured hepatocellular carcinoma (SRHCC). METHODS PubMed, EMBASE, the Cochrane Library, and Web of Science were all searched up for relevant studies regarding prognostic factors with SRHCC. RevMan5.3 software and Stata 14.0 software were used for statistical analysis. RESULTS A total of nineteen studies with 1876 resected SRHCC patients were finally identified. Pooled results indicated that preoperative AFP (high vs low) (P = 0.003), concurrent liver cirrhosis (yes vs no) (P = 0.02), preoperative liver function (child A vs non-child A) (P = 0.0007), tumor size (large vs small) (P < 0.00001), tumor number (solitary vs multiple) (P = 0.002), satellite foci (yes vs no) (P = 0.0006), micro-vascular invasion (yes vs no) (P < 0.00001), type of hepatectomy (major or minor) (P = 0.04), surgical margin (R + vs R -) (P < 0.00001), and type of hepatectomy (emergency hepatectomy vs staged hepatectomy) (P = 0.005) were prognostic factors for overall survival among post-hepatectomy SRHCC patients. CONCLUSION Apart from some conventional prognostic factors identified in resected patients with SRHCC, numerous prognostic factors have also been unmasked, which might provide clinical reference to stratify patients with different therapeutic regimes.
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Affiliation(s)
- Tian-Run Lv
- Department of Biliary Tract Surgery, General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Fei Liu
- Department of Biliary Tract Surgery, General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Yan-Wen Jin
- Department of Biliary Tract Surgery, General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Hai-Jie Hu
- Department of Biliary Tract Surgery, General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Wen-Jie Ma
- Department of Biliary Tract Surgery, General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.
| | - Fu-Yu Li
- Department of Biliary Tract Surgery, General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.
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Dendane Y, Kharrasse G, Zazour A, Koulali H, Ismaili Z. Spontaneous Rupture of Hepatocellular Carcinoma With Fatal Outcome in a Patient Taking Direct-Acting Antivirals. Cureus 2023; 15:e46638. [PMID: 37937021 PMCID: PMC10627119 DOI: 10.7759/cureus.46638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2023] [Indexed: 11/09/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is one of the most common malignant tumors globally. Many complications are attributed to it, including spontaneous rupture, which is a serious and rare complication that can be life-threatening. Managing and detecting this condition might pose challenges, especially when there is no prior history of liver cirrhosis or tumor. We report on a 57-year-old man followed as an outpatient for chronic hepatitis C who presented to the emergency department for abdominal pain with abdominal distention and jaundice, occurring two months after treatment by direct-acting antiviral (DAA). He was not known to have a liver tumor on the ultrasound performed before the start of treatment. Therefore, the diagnosis of tumor rupture was not very clear. The evolution was fatal, and death occurred quickly. Although the association between DAA treatment and hepatocarcinogenesis and its possible complications is unknown, close monitoring by high-performance imaging is probably required in patients under DAA.
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Affiliation(s)
- Youness Dendane
- Hepato-Gastroenterology, Digestive Disease Research Laboratory, Mohammed VI University Hospital Center/Mohammed First University, Oujda, MAR
| | - Ghizlane Kharrasse
- Gastroenterology and Hepatology, Mohammed VI University Hospital Center/Mohammed First University, Oujda, MAR
| | - Abdelkrim Zazour
- Gastroenterology and Hepatology, Mohammed VI University Hospital Center/Mohammed First University, Oujda, MAR
| | - Hajar Koulali
- Gastroenterology and Hepatology, Mohammed VI University Hospital Center/Mohammed First University, Oujda, MAR
| | - Zahi Ismaili
- Gastroenterology and Hepatology, Mohammed VI University Hospital Center/Mohammed First University, Oujda, MAR
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Conticchio M, Delvecchio A, Ferraro V, Stasi M, Casella A, Chetta N, De Marinis E, Madaro A, Raele M, Filippo R, Ammendola M, Tedeschi M, dèAngelis N, Memeo R. Robotic emergency liver resection of ruptured hepatocellular carcinoma. Int J Med Robot 2023; 19:e2537. [PMID: 37222177 DOI: 10.1002/rcs.2537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 04/14/2023] [Accepted: 05/12/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND The spontaneous rupture of hepatocellular carcinoma (HCC) is a rare complication. The management of this complication needs a stepwise, multidisciplinary approach which considers first of all clinical conditions of the patient and also the possibility of the best curative treatment. METHODS We report our experience of an emergency robotic liver resection for a ruptured HCC in an elderly patient. Minimally invasive liver resection is currently recognised as a safe and feasible approach to the treatment of HCC in elderly patients. RESULTS Our patient presented haemodynamic stability, which allows us to perform a robotic resection of segment 3. To our knowledge, this is the first report of the application of a robotic platform in an emergency setting for liver resection. CONCLUSIONS Rupture of HCC is an uncommon complication, burdened by a high rate of mortality. Its management still remains controversial. Treatment should be individualised taking into consideration the clinical status of the patient, tumour features and possibility of centre therapeutic strategy.
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Affiliation(s)
- Maria Conticchio
- Unit of Hepato-Biliary and Pancreatic Surgery, "F. Miulli" General Hospital, Bari, Italy
| | - Antonella Delvecchio
- Unit of Hepato-Biliary and Pancreatic Surgery, "F. Miulli" General Hospital, Bari, Italy
| | - Valentina Ferraro
- Unit of Hepato-Biliary and Pancreatic Surgery, "F. Miulli" General Hospital, Bari, Italy
| | - Matteo Stasi
- Unit of Hepato-Biliary and Pancreatic Surgery, "F. Miulli" General Hospital, Bari, Italy
| | - Annachiara Casella
- Unit of Hepato-Biliary and Pancreatic Surgery, "F. Miulli" General Hospital, Bari, Italy
| | - Nicola Chetta
- Unit of Hepato-Biliary and Pancreatic Surgery, "F. Miulli" General Hospital, Bari, Italy
| | - Emma De Marinis
- Unit of Hepato-Biliary and Pancreatic Surgery, "F. Miulli" General Hospital, Bari, Italy
| | - Andrea Madaro
- Unit of Hepato-Biliary and Pancreatic Surgery, "F. Miulli" General Hospital, Bari, Italy
| | - Margherita Raele
- Unit of Hepato-Biliary and Pancreatic Surgery, "F. Miulli" General Hospital, Bari, Italy
| | - Rosalinda Filippo
- Unit of Hepato-Biliary and Pancreatic Surgery, "F. Miulli" General Hospital, Bari, Italy
| | - Michele Ammendola
- Department of Medical and Surgical Sciences, Clinical Surgery Unit, University of 'Magna Graecia' Medical School, Germaneto Campus, Catanzaro, Italy
| | - Michele Tedeschi
- Unit of Hepato-Biliary and Pancreatic Surgery, "F. Miulli" General Hospital, Bari, Italy
| | - Nicola dèAngelis
- UCARE Department, Unit of Digestive, Hepatobiliary, and Pancreatic Surgery, Henri Mondor University Hospital (AP-HP), Créteil, France
| | - Riccardo Memeo
- Unit of Hepato-Biliary and Pancreatic Surgery, "F. Miulli" General Hospital, Bari, Italy
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Fowler KJ, Bashir MR, Fetzer DT, Kitao A, Lee JM, Jiang H, Kielar AZ, Ronot M, Kamaya A, Marks RM, Elsayes KM, Tang A, Sirlin CB, Chernyak V. Universal Liver Imaging Lexicon: Imaging Atlas for Research and Clinical Practice. Radiographics 2023; 43:e220066. [PMID: 36427260 DOI: 10.1148/rg.220066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The use of standardized terms in assessing and reporting disease processes has well-established benefits, such as clear communication between radiologists and other health care providers, improved diagnostic accuracy and reproducibility, and the enhancement and facilitation of research. Recently, the Liver Imaging Reporting and Data System (LI-RADS) Steering Committee released a universal liver imaging lexicon. The current version of the lexicon includes 81 vetted and precisely defined terms that are relevant to acquisition of images using all major liver imaging modalities and contrast agents, as well as lesion- and organ-level features. Most terms in the lexicon are applicable to all patients undergoing imaging of the liver, and only a minority of the terms are strictly intended to be used for patients with high risk factors for hepatocellular carcinoma. This pictorial atlas familiarizes readers with the liver imaging lexicon and includes discussion of general concepts, providing sample definitions, schematics, and clinical examples for a subset of the terms in the liver imaging lexicon. The authors discuss general, technical, and imaging feature terms used commonly in liver imaging, with the goal of illustrating their use for clinical and research applications. Work of the U.S. Government published under an exclusive license with the RSNA. Online supplemental material is available for this article.
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Affiliation(s)
- Kathryn J Fowler
- From the Liver Imaging Group, Department of Radiology, UC San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology, Duke University Health System, Durham, NC (M.R.B.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan (A.Kitao); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.L.); Department of Radiology, West China Hospital, Sichuan University, Chengdu, China (H.J.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology, Université Paris Cité, Paris, France, and Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.Kamaya); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, Md (R.M.M.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Quebec, Canada (A.T.); and Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 (V.C.)
| | - Mustafa R Bashir
- From the Liver Imaging Group, Department of Radiology, UC San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology, Duke University Health System, Durham, NC (M.R.B.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan (A.Kitao); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.L.); Department of Radiology, West China Hospital, Sichuan University, Chengdu, China (H.J.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology, Université Paris Cité, Paris, France, and Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.Kamaya); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, Md (R.M.M.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Quebec, Canada (A.T.); and Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 (V.C.)
| | - David T Fetzer
- From the Liver Imaging Group, Department of Radiology, UC San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology, Duke University Health System, Durham, NC (M.R.B.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan (A.Kitao); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.L.); Department of Radiology, West China Hospital, Sichuan University, Chengdu, China (H.J.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology, Université Paris Cité, Paris, France, and Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.Kamaya); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, Md (R.M.M.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Quebec, Canada (A.T.); and Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 (V.C.)
| | - Azusa Kitao
- From the Liver Imaging Group, Department of Radiology, UC San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology, Duke University Health System, Durham, NC (M.R.B.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan (A.Kitao); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.L.); Department of Radiology, West China Hospital, Sichuan University, Chengdu, China (H.J.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology, Université Paris Cité, Paris, France, and Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.Kamaya); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, Md (R.M.M.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Quebec, Canada (A.T.); and Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 (V.C.)
| | - Jeong Min Lee
- From the Liver Imaging Group, Department of Radiology, UC San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology, Duke University Health System, Durham, NC (M.R.B.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan (A.Kitao); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.L.); Department of Radiology, West China Hospital, Sichuan University, Chengdu, China (H.J.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology, Université Paris Cité, Paris, France, and Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.Kamaya); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, Md (R.M.M.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Quebec, Canada (A.T.); and Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 (V.C.)
| | - Hanyu Jiang
- From the Liver Imaging Group, Department of Radiology, UC San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology, Duke University Health System, Durham, NC (M.R.B.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan (A.Kitao); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.L.); Department of Radiology, West China Hospital, Sichuan University, Chengdu, China (H.J.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology, Université Paris Cité, Paris, France, and Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.Kamaya); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, Md (R.M.M.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Quebec, Canada (A.T.); and Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 (V.C.)
| | - Ania Z Kielar
- From the Liver Imaging Group, Department of Radiology, UC San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology, Duke University Health System, Durham, NC (M.R.B.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan (A.Kitao); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.L.); Department of Radiology, West China Hospital, Sichuan University, Chengdu, China (H.J.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology, Université Paris Cité, Paris, France, and Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.Kamaya); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, Md (R.M.M.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Quebec, Canada (A.T.); and Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 (V.C.)
| | - Maxime Ronot
- From the Liver Imaging Group, Department of Radiology, UC San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology, Duke University Health System, Durham, NC (M.R.B.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan (A.Kitao); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.L.); Department of Radiology, West China Hospital, Sichuan University, Chengdu, China (H.J.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology, Université Paris Cité, Paris, France, and Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.Kamaya); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, Md (R.M.M.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Quebec, Canada (A.T.); and Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 (V.C.)
| | - Aya Kamaya
- From the Liver Imaging Group, Department of Radiology, UC San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology, Duke University Health System, Durham, NC (M.R.B.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan (A.Kitao); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.L.); Department of Radiology, West China Hospital, Sichuan University, Chengdu, China (H.J.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology, Université Paris Cité, Paris, France, and Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.Kamaya); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, Md (R.M.M.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Quebec, Canada (A.T.); and Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 (V.C.)
| | - Robert M Marks
- From the Liver Imaging Group, Department of Radiology, UC San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology, Duke University Health System, Durham, NC (M.R.B.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan (A.Kitao); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.L.); Department of Radiology, West China Hospital, Sichuan University, Chengdu, China (H.J.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology, Université Paris Cité, Paris, France, and Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.Kamaya); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, Md (R.M.M.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Quebec, Canada (A.T.); and Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 (V.C.)
| | - Khaled M Elsayes
- From the Liver Imaging Group, Department of Radiology, UC San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology, Duke University Health System, Durham, NC (M.R.B.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan (A.Kitao); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.L.); Department of Radiology, West China Hospital, Sichuan University, Chengdu, China (H.J.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology, Université Paris Cité, Paris, France, and Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.Kamaya); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, Md (R.M.M.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Quebec, Canada (A.T.); and Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 (V.C.)
| | - An Tang
- From the Liver Imaging Group, Department of Radiology, UC San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology, Duke University Health System, Durham, NC (M.R.B.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan (A.Kitao); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.L.); Department of Radiology, West China Hospital, Sichuan University, Chengdu, China (H.J.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology, Université Paris Cité, Paris, France, and Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.Kamaya); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, Md (R.M.M.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Quebec, Canada (A.T.); and Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 (V.C.)
| | - Claude B Sirlin
- From the Liver Imaging Group, Department of Radiology, UC San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology, Duke University Health System, Durham, NC (M.R.B.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan (A.Kitao); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.L.); Department of Radiology, West China Hospital, Sichuan University, Chengdu, China (H.J.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology, Université Paris Cité, Paris, France, and Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.Kamaya); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, Md (R.M.M.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Quebec, Canada (A.T.); and Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 (V.C.)
| | - Victoria Chernyak
- From the Liver Imaging Group, Department of Radiology, UC San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology, Duke University Health System, Durham, NC (M.R.B.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan (A.Kitao); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.L.); Department of Radiology, West China Hospital, Sichuan University, Chengdu, China (H.J.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology, Université Paris Cité, Paris, France, and Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.Kamaya); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, Md (R.M.M.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Quebec, Canada (A.T.); and Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 (V.C.)
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Comparison of the prognosis of BCLC stage A ruptured hepatocellular carcinoma patients after undergoing transarterial chemoembolization (TACE) or hepatectomy: a propensity score-matched landmark analysis. Surg Endosc 2022; 36:8992-9000. [PMID: 35920912 DOI: 10.1007/s00464-022-09351-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 05/20/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND At present, the choice of treatment modalities for ruptured hepatocellular carcinoma patients in BCLC stage A remains controversial, and this study compared the overall survival of ruptured HCC patients undergoing TACE or hepatectomy. METHODS A total of 283 ruptured HCC patients treated at our liver surgery center were included in our study, of which 175 were treated with hepatectomy and 108 were treated with TACE. To reduce selection bias, we used a propensity score matching (PSM) model, which yielded a total of 88 pairs of patients. We used the Kaplan-Meier method to compare the long-term prognosis, and the Landmark method was used to compare the short-term and long-term prognoses of patients after PSM. Finally, we performed subgroup analysis according to whether it met the Milan criteria. RESULTS After PSM, in the hepatectomy group, the 1-, 3-, and 5 year OS rates were 73.4%, 45.4%, and 33.9%, respectively. In the TACE group, the 1-, 3-, and 5 year OS rates were 58.5%, 40.6%, and 23.2%, respectively. Within one year, the hepatectomy group had a better prognosis than the TACE group (P = 0.022), but there was no difference in long-term survival(P = 0.936). In the subgroup analysis, in patients who met the Milan criteria, the survival curve indicated that there was no statistically significant difference in the survival prognosis between the two groups (P = 0.294) HR = 1.56(0.68-3.59); in the patients beyond the Milan criteria, the survival time was 28.0 months (20.0-34.0) in patients who underwent hepatectomy and 18 months (9.8-26.2) in patients who underwent TACE, and the survival curve indicated a statistically significant difference (P = 0.043) HR = 1.57(1.01-2.43). CONCLUSION Our propensity score-matched study found that ruptured HCC patients treated by hepatectomy had a better short-term prognosis than those treated by TACE, but there was no difference in the long-term prognosis between the two treatment groups.
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Park J, Jeong YS, Suh YS, Kim HC, Chung JW, Choi JW. Clinical course and role of embolization in patients with spontaneous rupture of hepatocellular carcinoma. Front Oncol 2022; 12:999557. [PMID: 36132134 PMCID: PMC9483098 DOI: 10.3389/fonc.2022.999557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 08/16/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundA diverse clinical course after the spontaneous rupture of hepatocellular carcinoma (HCC) renders nonstandardized treatment protocols.PurposeTo evaluate clinical course and role of transcatheter arterial embolization (TAE) in patients with rupture of HCC.Materials and methodsThis retrospective study included 127 patients who were treated for ruptured HCC at single institution between 2005 and 2014. After multidisciplinary discussion, patients underwent medical management, TAE, emergency surgery or staged surgery. Patients were retrospectively divided into two groups based on the intent of treatment: curative and palliative. The rebleeding rate and 1-month and overall survival (OS) were compared between two groups. The incidence and survival of patients with intraperitoneal drop metastasis (IPDM) were also analyzed.ResultsThe overall rebleeding rate in patients who underwent TAE was 3.1% (3/96). One-month mortality rate was 6.3% (8/127). The rebleeding and 1-month mortality rates were not significantly different between two groups. OS was significantly higher in the curative treatment group (median: 12.0 vs 2.2 months, p<0.001). Among 96 patients who initially received TAE, ten patients underwent staged operation (10.4%). The median OS for medical management, TAE, emergency surgery and staged surgery was 2.8, 8.7, 19.1 and 71.1 months, respectively. Of all patients, 15.2% developed IPDM mostly within 1 year and their survival was poorer than that of patients without IPDM (median: 6.3 vs. 15.1 months, p<0.001).ConclusionTAE provided effective immediate hemostasis with a low rebleeding rate and may serve as a bridge to elective surgery. IPDM frequently occurred within 1 year and manifested poor survival; thus, close surveillance should be considered for patients with spontaneous rupture of HCC.
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Affiliation(s)
- Juil Park
- Department of Radiology, Severance Hospital, Seoul, South Korea
| | - Yun Soo Jeong
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea
| | - Yun Seok Suh
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyo-Cheol Kim
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea
| | - Jin Wook Chung
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea
| | - Jin Woo Choi
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea
- *Correspondence: Jin Woo Choi,
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14
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Yan J, Li T, Deng M, Fan H. Ruptured Hepatocellular Carcinoma: What Do Interventional Radiologists Need to Know? Front Oncol 2022; 12:927123. [PMID: 35785181 PMCID: PMC9243354 DOI: 10.3389/fonc.2022.927123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 05/16/2022] [Indexed: 11/13/2022] Open
Abstract
Rupture of HCC (rHCC) is a life-threatening complication of hepatocellular carcinoma (HCC), and rHCC may lead to a high rate of peritoneal dissemination and affect survival negatively. Treatment for rHCC mainly includes emergency surgery, interventional therapies, and palliative treatment. However, the management of rHCC should be carefully evaluated. For patients with severe bleeding, who are not tolerant to open surgery, quick hemostatic methods such as rupture tissue ablation and TAE/TACE can be performed. We described clinical presentation, prognosis, complication, interventional management, and current evidence of rHCC from the perspective of interventional radiologists. Overall, our review summarized that interventional therapies are necessary for most patients with rHCC to achieve hemostasis, even in some patients with Child–Pugh C. Moreover, TAE/TACE followed by staged hepatectomy is a beneficial treatment for rHCC according to current clinical evidence. TAE/TACE is the first choice for most patients with rHCC, and appropriate interventional treatment may provide staged surgery opportunities for those who are not tolerant to emergency surgery to reach an ideal prognosis.
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Affiliation(s)
- Jingxin Yan
- Department of Interventional Therapy, Affiliated Hospital of Qinghai University, Xining, China
- Department of Postgraduate, Qinghai University, Xining, China
- *Correspondence: Jingxin Yan, ; Haining Fan,
| | - Ting Li
- Department of Orthopedics, Sichuan Provincial People’s Hospital, Chengdu, China
- Department of Postgraduate, Chengdu Medical College, Chengdu, China
| | - Manjun Deng
- Department of Hepatopancreatobiliary Surgery, Affiliated Hospital of Qinghai University, Xining, China
- Qinghai Province Key Laboratory of Hydatid Disease Research, Xining, China
| | - Haining Fan
- Department of Hepatopancreatobiliary Surgery, Affiliated Hospital of Qinghai University, Xining, China
- Qinghai Province Key Laboratory of Hydatid Disease Research, Xining, China
- *Correspondence: Jingxin Yan, ; Haining Fan,
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15
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Yan J, Li T, Deng M, Fan H. Ruptured Hepatocellular Carcinoma: What Do Interventional Radiologists Need to Know? Front Oncol 2022. [DOI: 10.3389/fonc.2022.927123\] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Rupture of HCC (rHCC) is a life-threatening complication of hepatocellular carcinoma (HCC), and rHCC may lead to a high rate of peritoneal dissemination and affect survival negatively. Treatment for rHCC mainly includes emergency surgery, interventional therapies, and palliative treatment. However, the management of rHCC should be carefully evaluated. For patients with severe bleeding, who are not tolerant to open surgery, quick hemostatic methods such as rupture tissue ablation and TAE/TACE can be performed. We described clinical presentation, prognosis, complication, interventional management, and current evidence of rHCC from the perspective of interventional radiologists. Overall, our review summarized that interventional therapies are necessary for most patients with rHCC to achieve hemostasis, even in some patients with Child–Pugh C. Moreover, TAE/TACE followed by staged hepatectomy is a beneficial treatment for rHCC according to current clinical evidence. TAE/TACE is the first choice for most patients with rHCC, and appropriate interventional treatment may provide staged surgery opportunities for those who are not tolerant to emergency surgery to reach an ideal prognosis.
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16
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Huang X, Jia C, Xu L, Bi X, Lai F, Huang Z, Li X, Yin X, Ni Y, Che X. Survival of Patients Subjected to Hepatectomy After Spontaneous Rupture of Hepatocellular Carcinoma: A Meta-analysis of High-quality Propensity Score Matching Studies. Front Oncol 2022; 12:877091. [PMID: 35664745 PMCID: PMC9160741 DOI: 10.3389/fonc.2022.877091] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/21/2022] [Indexed: 12/03/2022] Open
Abstract
Background The spontaneous rupture of hepatocellular carcinoma (HCC) is associated with high mortality rates, and liver resection can provide better outcomes than other available treatments. However, the survival length of patients subjected to hepatectomy after spontaneous rupture of hepatocellular carcinoma remains controversial. Method Articles reporting the comparison of the survival outcome between patients with rupture HCC (rHCC) and non-rupture HCC (nrHCC) from the inception until December 31, 2021 by PubMed, Web of Science, OVID, and the Cochrane Library databases were included. The high-quality propensity score matching analysis was used to investigate the impact of rupture on disease-free survival (DFS) and overall survival (OS) between the rHCC and nrHCC group with no heterogeneity. Result A total of 606 patients from six cohort studies were included. The major baseline characteristics of the eligible patients were well balanced between rHCC and nrHCC group. The 1-, 3-, and 5-year hazard ratios of DFS were 3.45 (95% confidence interval [CI] 2.54–4.68), 3.63 (95% CI 2.87–4.60), and 3.72 (95% CI 2.93–4.72), respectively. The 1-, 3-, and 5-year hazard ratios of OS were 5.01 (95% CI 3.26–7.69), 5.49 (95% CI 4.08–7.39), and 4.20 (95% CI 3.20–5.51), respectively. Conclusion The present meta-analysis demonstrated that the DSF and OS were significantly shorter in the rHCC group than in the nrHCC group, thus revealing that spontaneous HCC rupture was a predictor of poor survival.
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Affiliation(s)
- Xiaozhun Huang
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Chenyang Jia
- Department of Hepatopancreatobiliary Surgery, Second People's Hospital, First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Lin Xu
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Xinyu Bi
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fengyong Lai
- Department of Intervention, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Zhangkan Huang
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Xiaoqing Li
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Xin Yin
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Yong Ni
- Department of Hepatopancreatobiliary Surgery, Second People's Hospital, First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Xu Che
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
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17
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Xia F, Huang Z, Zhang Q, Ndhlovu E, Zhang M, Chen X, Zhang B, Zhu P. Early-Stage Ruptured Hepatocellular Carcinoma With Different Tumor Diameters: Small Tumors Have a Better Prognosis. Front Oncol 2022; 12:865696. [PMID: 35656507 PMCID: PMC9152538 DOI: 10.3389/fonc.2022.865696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 04/08/2022] [Indexed: 11/13/2022] Open
Abstract
Background and Aim Ruptured hepatocellular carcinoma (rHCC) is classified as T4 according to the TNM staging system with a very poor (does not achieve expected) prognosis, which has always been controversial. This study aimed at assessing the specific impact of different tumor diameters on the posttreatment prognosis of BCLC stage 0/A rHCC patients. Methods Data from 258 patients with BCLC stage 0/A HCC treated in our center from January 2008 to December 2017 were collected, including 143 rHCC patients and 115 patients with non-ruptured HCC (nrHCC). With the help of X-tile software, we determined the cutoff value of the tumor diameter in patients with rHCC. Using 8 cm as the cutoff, we divided rHCC patients into Small-rHCC (n = 96) and Large-rHCC (n = 47) groups, compared the prognoses of the S-rHCC and L-rHCC groups, as well as the prognoses of the two groups with the nrHCC group using the Kaplan–Meier method, and screened the prognostic factors of rHCC patients using the multivariate Cox risk model. Results The OS of the S-rHCC group was significantly higher than that of the L-rHCC group [HR = 2.41 (1.60–3.63)], and the OS of the nrHCC group was comparable to that of the S-rHCC group (P = 0.204). In patients treated with surgery only, OS and RFS were also comparable in the S-rHCC nrHCC group. Meanwhile, multivariate Cox regression analysis revealed that alpha-fetoprotein (AFP), alkaline phosphatase (ALP), and the main method of treatment were also prognostic factors for OS in patients with rHCC. Conclusions Ruptured HCC with a relatively small diameter (≤8 cm) can also achieve the same prognosis as nrHCC patients after aggressive treatment. It is also not recommended to include all patients with rHCC in stage T4.
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Affiliation(s)
- Feng Xia
- Department of Hepatic Surgery, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Zhiyuan Huang
- Department of Hepatic Surgery, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Qiao Zhang
- Guangdong Medical University, Zhanjiang, China
| | - Elijah Ndhlovu
- Department of Hepatic Surgery, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Mingyu Zhang
- Department of Digestive Medicine, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoping Chen
- Department of Hepatic Surgery, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Bixiang Zhang
- Department of Hepatic Surgery, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Peng Zhu
- Department of Hepatic Surgery, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
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18
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Zou J, Yuan J, Chen H, Zhou X, Xue T, Chen R, Zhang L, Ren Z. Development of a prognostic score for recommended transarterial chemoembolization candidates with spontaneous rupture of hepatocellular carcinoma. J Gastrointest Oncol 2022; 13:1376-1383. [PMID: 35837157 PMCID: PMC9274030 DOI: 10.21037/jgo-22-531] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 06/16/2022] [Indexed: 08/15/2023] Open
Abstract
BACKGROUND Although transarterial chemoembolization (TACE) has been widely used for treating the spontaneous rupture of hepatocellular carcinoma (HCC), no existing model exists for predicting survival. The aim of this study was thus to develop and validate a nomogram for estimating the prognosis in patients with ruptured HCC upon undergoing TACE treatment. METHODS This study included 55 patients with spontaneously ruptured HCC who underwent TACE treatment between January 2015 and April 2019. The diagnosis of spontaneous HCC rupture was based on the disruption of the peritumoral liver capsule with surrounding fluid in the perihepatic region. The prognostic nomogram was constructed using the independent predictors assessed by the multivariate Cox proportional hazards model. RESULTS The median overall survival (OS) was 6.4 months, with 6-month and 1-year survival rates of 52.7% and 41.8%, respectively. In the univariate analysis, the size of the largest tumor, total bilirubin (TBIL) levels, and aspartate aminotransferase (AST) levels were associated with the OS of patients. Multivariate analysis suggested that TBIL levels (HR =0.358, P=0.036) and diameter of the largest tumor (HR =1.012, P=0.044) were independent prognostic factors for predicting the OS. Based on these variables, we developed and validated a nomogram for the risk stratification of HCC rupture after TACE treatment for individual patients. According to the nomogram risk assessment, we were able to evaluate the approximate 1- and 2-year survival rates based on patients' tumor diameter and TBIL level after TACE treatment of ruptured HCC. The concordance index for the OS prediction was 0.748 (95% CI: 0.691-0.805). This newly developed nomogram represents an intuitive tool for predicting the OS of patients with ruptured HCC. CONCLUSIONS This study indicated that TBIL levels and diameter of the largest tumor were independent prognostic factors for predicting the OS of ruptured HCC. This study may help maximize favorable TACE treatment outcomes.
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Affiliation(s)
- Jixue Zou
- Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jia Yuan
- Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hong Chen
- Department of Hepatic Oncology, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen, China
| | - Xinghao Zhou
- Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Tongchun Xue
- Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Rongxin Chen
- Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lan Zhang
- Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhenggang Ren
- Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China
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19
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Lee CY, Chau GY, Wei CY, Chao Y, Huang YH, Huo TI, Hou MC, Su YH, Wu JC, Su CW. Surgical resection could provide better outcomes for patients with hepatocellular carcinoma and tumor rupture. Sci Rep 2022; 12:8343. [PMID: 35585167 PMCID: PMC9117281 DOI: 10.1038/s41598-022-12350-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 05/10/2022] [Indexed: 12/24/2022] Open
Abstract
We investigated the outcomes of patients with ruptured hepatocellular carcinoma (HCC) and identified the optimal treatment modality for such patients. We retrospectively enrolled 91 patients with treatment-naive HCC and tumor rupture at diagnosis, including 38 patients who underwent surgical resection (SR) alone, 28 patients who were treated with transarterial chemoembolization (TACE) only, 20 patients who had a sequential combination therapy of TACE and SR, and 5 patients who received best supportive care. After a median follow-up of 13.1 months, 54 patients died. The cumulative 5 years overall survival (OS) rates were 55.1% and 0% in the SR group and non-SR group, respectively (p < 0.001). Non-SR therapy was associated with poorer OS according to a multivariate analysis with a hazard ratio of 6.649 (95% confidence interval 3.581–12.344, p < 0.001). Moreover, whether patients received TACE or not did not impact the OS in both the SR group and the non-SR group. In conclusion, for patients with HCC and tumor rupture at the time of diagnosis, SR could lead to better prognoses than non-surgery treatment modalities. Moreover, a sequential combination of TACE and SR had similar clinical outcomes when compared to SR alone.
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Affiliation(s)
- Chun-Yang Lee
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Peitou District, Taipei, 11217, Taiwan
| | - Gar-Yang Chau
- Department of Internal Medicine, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Cheng-Yi Wei
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Peitou District, Taipei, 11217, Taiwan.,Department of Internal Medicine, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yee Chao
- Department of Internal Medicine, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yi-Hsiang Huang
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Peitou District, Taipei, 11217, Taiwan.,Institute of Clinical Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Teh-Ia Huo
- Division of Basic Research, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Pharmacology, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ming-Chih Hou
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Peitou District, Taipei, 11217, Taiwan.,Department of Internal Medicine, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yu-Hui Su
- Department of Accounting, School of Business, Soochow University, Taipei, Taiwan
| | - Jaw-Ching Wu
- Institute of Clinical Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chien-Wei Su
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Peitou District, Taipei, 11217, Taiwan. .,Department of Internal Medicine, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan. .,Institute of Clinical Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan. .,Hospitalist Ward, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan. .,Biomedical Science and Engineering Center, National Tsing Hua University, Hsinchu, Taiwan.
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20
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21
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Lee JE, Park JW, Lee IJ, Kim BH, Kim SH, Kim HB. Ruptured Massive Hepatocellular Carcinoma Cured by Transarterial Chemoembolization. JOURNAL OF LIVER CANCER 2020; 20:154-159. [PMID: 37384322 PMCID: PMC10035677 DOI: 10.17998/jlc.20.2.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 02/13/2020] [Accepted: 02/26/2020] [Indexed: 06/30/2023]
Abstract
Spontaneous tumor rupture is a serious but rare complication of hepatocellular carcinoma (HCC) and has a low survival rate. Here, we report a case of massive HCC that ruptured and was treated successfully with transarterial chemoembolization (TACE). A 55-year-old man with abdominal pain was diagnosed with a 12-cm-wide ruptured HCC at segment 8. The overall liver function was scored as Child-Pugh A, but the single nodule tumor had ruptured; therefore, TACE treatment was initiated. After the first TACE treatment, residual tumors were found; thus, secondary TACE was performed 5 months later. No new lesions or extrahepatic metastases were found 16 months after the first TACE treatment, so hepatic resection was performed for curative treatment. The postoperative pathology results did not reveal any cancer cells; hence, TACE alone resulted in a cure. We report this case because the cure has been maintained for more than 3 years after resection.
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Affiliation(s)
- Ji Eun Lee
- Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang, Korea
| | - Joong-Won Park
- Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang, Korea
| | - In Joon Lee
- Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang, Korea
| | - Bo Hyun Kim
- Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang, Korea
| | - Seoung Hoon Kim
- Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang, Korea
| | - Hyun Beom Kim
- Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang, Korea
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22
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Zheng YJ, Li DL, Luo D, Chen XP, Zhang B, Fang C, Gan Y, Li B, Su S. Early versus Delayed Hepatectomy for Spontaneously Ruptured Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis. J INVEST SURG 2020; 34:1214-1222. [PMID: 32654535 DOI: 10.1080/08941939.2020.1792009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Here, we aimed to compare early hepatectomy (EH) with delayed hepatectomy (DH) as a treatment for spontaneously ruptured hepatocellular carcinoma (HCC). METHODS Several databases were systematically searched for eligible studies that compared DH with EH for spontaneously ruptured HCC treatment. Studies that met the inclusion criteria were reviewed systematically, and the reported data were aggregated statistically, using the RevMan v5.3 software. RESULTS Seven studies were included, with a total of 385 patients, comprising of 224 EH cases and 161 DH cases. Compared with the EH group, incidence of intraoperative bleeding [mean difference (MD), 353.93; 95% CI, 230.04-447.83; P < 0.00001], volume of intraoperative blood transfusion (MD, 420.61; 95% CI, 354.40-486.81, P < 0.00001), and 30-day mortality rate (OR, 14.94; 95% CI, 1.76-126.66; P = 0.01) were significantly lower in the DH group. Furthermore, the 1-, 2-, and 3-year survival rates were significantly higher in the DH group [1-year:hazard ratio (HR), 1.76; 95% CI, 1.06-2.94; P = 0.03; 2-year:HR, 1.52; 95% CI, 1.02-2.25; P = 0.04; 3-year: HR, 1.53; 95% CI, 1.06-2.21; P = 0.02]. There was no difference between the groups in the 5-year survival rate (HR, 1.40; 95% CI, 0.92-2.11; P = 0.11). CONCLUSION For resectable spontaneously ruptured HCC, DH could reduce intraoperative bleeding, intraoperative blood transfusion volume, and 30-day mortality rate and increase the 1-, 2-, and 3-year survival rates, endowing the patients with greater short- and long-term benefits during and following the surgery.
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Affiliation(s)
- Ying-Jun Zheng
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou City, China.,Academician (Expert) Workstation of Sichuan Province, Luzhou City, China
| | - Dong-Lun Li
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou City, China.,Academician (Expert) Workstation of Sichuan Province, Luzhou City, China
| | - De Luo
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou City, China.,Academician (Expert) Workstation of Sichuan Province, Luzhou City, China
| | - Xin-Pei Chen
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou City, China.,Academician (Expert) Workstation of Sichuan Province, Luzhou City, China
| | - Bin Zhang
- General Surgery Department, Jingyan County people's Hospital, Leshan City, China
| | - Cheng Fang
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou City, China.,Academician (Expert) Workstation of Sichuan Province, Luzhou City, China
| | - Yu Gan
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou City, China.,Academician (Expert) Workstation of Sichuan Province, Luzhou City, China
| | - Bo Li
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou City, China.,Academician (Expert) Workstation of Sichuan Province, Luzhou City, China
| | - Song Su
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou City, China.,Academician (Expert) Workstation of Sichuan Province, Luzhou City, China
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23
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Xu X, Chen C, Liu Q, Huang X. A Meta-analysis of TAE/TACE Versus Emergency Surgery in the Treatment of Ruptured HCC. Cardiovasc Intervent Radiol 2020; 43:1263-1276. [PMID: 32440961 DOI: 10.1007/s00270-020-02514-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 05/02/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To evaluate the efficacy and safety of TAE/TACE versus emergency surgery (ES) for spontaneous rupture of HCC (rHCC). METHODS Eight databases (Web of Science, Pubmed, Embase, Cochrane Library, ClinicalTrial.gov, Wanfang, CNKI and VIP) were searched to obtain all related literature from the inception dates to October 2019. Subgroup analyses based on the kind of study design and kind of embolization were conducted. RESULTS Twenty-one studies comparing TAE/TACE with ES were eligible. A total of 974 rHCC participants (485 participants treated with TACE/TAE and 489 participants treated with ES) were included in the present meta-analysis. TAE/TACE group was associated with lower risk of complications (OR = 0.36; 95% CI, 0.22-0.57; P < 0.0001) and in-hospital mortality (OR = 0.52; 95% CI, 0.29-0.94; P = 0.03) compared with ES group. In addition, no significant difference in successful hemostasis (OR = 1.67; 95% CI, 0.85-3.28; P = 0.13) and 1-year survival (OR = 1.08; 95% CI, 0.79-1.48; P = 0.64) between TAE/TACE and ES groups was demonstrated. CONCLUSIONS TAE/TACE had comparable outcomes to ES in terms of successful hemostasis and 1-year survival. Meanwhile, TAE/TACE was significantly superior to ES in terms of complications and in-hospital mortality. Therefore, TAE/TACE may be recommended as a preferable treatment for rHCC.
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Affiliation(s)
- Xinjian Xu
- Department of Radiology, Shandong Medical Imaging Research Institute, Cheeloo College of Medicine, Shandong University, Jinan, 250021, Shandong, China
- Department of Interventional Radiology, Jiang yin people's hospital, No. 3, Yingrui Road, Jiangyin, 214400, Jiangsu, China
| | - Changsheng Chen
- Department of Human Resources, Department of Radiology, Jiang yin people's hospital, No. 3, Yingrui Road, Jiangyin, 214400, Jiangsu, China
| | - Qiang Liu
- Department of Radiology, Shandong Medical Imaging Research Institute, Cheeloo College of Medicine, Shandong University, Jinan, 250021, Shandong, China.
| | - Xiangzhong Huang
- Department of Interventional Radiology, Jiang yin people's hospital, No. 3, Yingrui Road, Jiangyin, 214400, Jiangsu, China.
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24
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Tanaka Y, Oosone A, Tsuchiya A. Usefulness of Virtual Fluoroscopy in Emergency Interventional Radiology. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2020; 81:852-862. [PMID: 36238185 PMCID: PMC9432217 DOI: 10.3348/jksr.2020.81.4.852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 07/22/2019] [Accepted: 09/04/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Yoshihiro Tanaka
- Department of Radiology, National Hospital Organization Mito Medical Center, Ibaraki, Japan
| | - Akitoshi Oosone
- Department of Radiology, National Hospital Organization Mito Medical Center, Ibaraki, Japan
| | - Asuka Tsuchiya
- Department of Emergency and Critical Care Medicine, National Hospital Organization Mito Medical Center, Ibaraki, Japan
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Kwak BJ, Park J, Kwon YK, Kwon JH, Yoon YC. Intraoperative radiofrequency ablation and distilled water peritoneal lavage for spontaneously ruptured hepatocellular carcinoma. Ann Surg Treat Res 2019; 97:291-295. [PMID: 31824883 PMCID: PMC6893220 DOI: 10.4174/astr.2019.97.6.291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 10/06/2019] [Accepted: 10/23/2019] [Indexed: 11/30/2022] Open
Abstract
Purpose Spontaneously ruptured hepatocellular carcinoma (srHCC) is known to be a life-threatening complication with poor prognosis. Although there are various treatment modalities, there is no definite treatment guideline. The purpose of this study was to review the surgical outcome and prognosis of srHCC treated with intraoperative radiofrequency ablation (RFA) and distilled water peritoneal lavage (DWPL). Methods From March 2012 to October 2018, 9 patients with srHCC who underwent emergent surgery were reviewed. After hematoma removal, intraoperative RFA and DWPL were applied to all patients. Hepatectomy was performed if necessary. Patients with multiple tumors, distant metastasis, and vascular tumor involvement in radiologic imaging were excluded. Results Six of 9 patients with diameters less than 7 cm were able to obtain hemostasis using RFA alone (RFA group). However, 3 patients with a tumor size of more than 10 cm underwent liver resection because they could not obtain hemostasis with RFA (hepatectomy only group). The RFA group had shorter operation time (148.3 ± 31.7 minutes vs. 251.7 ± 20.2 minutes, P < 0.05) and less red blood cell transfusion (5.8 ± 2.5 packs vs. 24.0 ± 11.5 packs, P < 0.05) than the hepatectomy only group. There was no peritoneal metastasis at long-term follow-up in the RFA group. Five-year recurrence-free survival rate was 0% in both groups. However, 5-year overall survival rate was better in the RFA group (83.3% vs. 0%, P < 0.05). Conclusion Intraoperative RFA and DWPL are easy to perform and theoretically the best methods for managing relatively small srHCC.
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Affiliation(s)
- Bong Jun Kwak
- Division of Hepatobiliary, Pancreas, and Abdominal Organ Transplant, Department of Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Joonseon Park
- Division of Hepatobiliary, Pancreas, and Abdominal Organ Transplant, Department of Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Yong Kyong Kwon
- Division of Hepatobiliary, Pancreas, and Abdominal Organ Transplant, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jung Hyun Kwon
- Division of Hepatology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Chul Yoon
- Division of Hepatobiliary, Pancreas, and Abdominal Organ Transplant, Department of Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
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Zou J, Li C, Chen Y, Chen R, Xue T, Xie X, Zhang L, Ren Z. Retrospective analysis of transcatheter arterial chemoembolization treatment for spontaneously ruptured hepatocellular carcinoma. Oncol Lett 2019; 18:6423-6430. [PMID: 31807165 PMCID: PMC6876292 DOI: 10.3892/ol.2019.11037] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 09/13/2019] [Indexed: 12/26/2022] Open
Abstract
Spontaneous rupture is one of the complications of hepatocellular carcinoma (HCC) associated with a high mortality rate. Transcatheter arterial chemoembolization (TACE) has been widely used in patients with ruptured liver tumors. The aim of the present study was to evaluate the benefits and safety of conventional TACE and the disease prognosis following TACE and surgery with regard to the progression of spontaneously ruptured HCC. The clinical data of 70 patients diagnosed with spontaneous rupture of HCC were retrospectively reviewed. The majority of adverse reactions that occurred following treatment were Grade 2 or below. Grade 3/4 events occurred in 20 patients (14.3%), which included gastrointestinal hemorrhage, cardiac failure, pulmonary embolism, shock and recurrent tumor rupture. All of these patients recovered and were discharged following symptomatic and supportive treatment, with the exception of two cases of severe hemorrhagic shock and hepatic failure prior to TACE treatment. These patients did not survive during the period of hospitalization. Multivariate analysis identified that a maximum tumor size >10 cm and a high serum total bilirubin level >30 µmol/l were independent factors for determining overall patient survival rate. Additionally, the overall survival rates at 1, 6 and 12 months were 92.3, 53.8 and 46.2% in the TACE group and 100, 87.1 and 54.8% in the surgery group, respectively. The overall survival rates at 1 and 6 months following TACE were lower than those of the surgery group (P<0.05). However, the overall survival rates at 12 months were similar (P>0.05). Patients in the TACE group had a shorter hospital admission compared with those in the resection group (median 7 vs. 13 days; P<0.01). Therefore, the data demonstrated that conventional TACE therapy was safe and effective for the treatment of spontaneously ruptured HCC. In addition, this type of therapy conferred a similar long-term survival rate with that of open surgery.
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Affiliation(s)
- Jixue Zou
- Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, P.R. China
| | - Chao Li
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200433, P.R. China
| | - Yi Chen
- Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, P.R. China
| | - Rongxin Chen
- Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, P.R. China
| | - Tongchun Xue
- Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, P.R. China
| | - Xiaoying Xie
- Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, P.R. China
| | - Lan Zhang
- Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, P.R. China
| | - Zhenggang Ren
- Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, P.R. China
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Chua DW, Koh YX, Allen JC, Chan CY, Lee SY, Cheow PC, Jeyaraj P, Teo JY, Chow PK, Chung AY, Ooi LL, Goh BK. Impact of spontaneous rupture on the survival outcomes after liver resection for hepatocellular carcinoma: A propensity matched analysis comparing ruptured versus non-ruptured tumors. Eur J Surg Oncol 2019; 45:1652-1659. [DOI: 10.1016/j.ejso.2019.03.044] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 03/24/2019] [Accepted: 03/30/2019] [Indexed: 12/12/2022] Open
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Plahuta I, Jelenko M, Potrč S, Ivanecz A. Abandonment of surveillance, followed by emergency surgery for a second spontaneous rupture of hepatocellular carcinoma: A case report and review of the literature. Clin Case Rep 2019; 7:789-796. [PMID: 30997087 PMCID: PMC6452480 DOI: 10.1002/ccr3.2097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 02/19/2019] [Accepted: 02/24/2019] [Indexed: 11/16/2022] Open
Abstract
Hepatocellular carcinoma (HCC) develops in the presence of chronic liver disease, and nonalcoholic fatty liver disease is becoming a frequent cause of HCC in developed regions. Spontaneous rupture of HCC (rHCC) is a potentially life-threatening complication of a tumor. The patient's compliance with surveillance after liver resection is vital for the prevention of rHCC.
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Affiliation(s)
- Irena Plahuta
- Department of Abdominal and General SurgeryUniversity Medical Centre MariborMariborSlovenia
| | | | - Stojan Potrč
- Department of Abdominal and General SurgeryUniversity Medical Centre MariborMariborSlovenia
| | - Arpad Ivanecz
- Department of Abdominal and General SurgeryUniversity Medical Centre MariborMariborSlovenia
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Sahu SK, Chawla YK, Dhiman RK, Singh V, Duseja A, Taneja S, Kalra N, Gorsi U. Rupture of Hepatocellular Carcinoma: A Review of Literature. J Clin Exp Hepatol 2019; 9:245-256. [PMID: 31024207 PMCID: PMC6476943 DOI: 10.1016/j.jceh.2018.04.002] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 04/18/2018] [Indexed: 12/12/2022] Open
Abstract
Approximately 700,000 people die of Hepatocellular Carcinoma (HCC) each year worldwide, making it the third leading cause of cancer related deaths. Rupture is a potentially life-threatening complication of HCC. The incidence of HCC rupture is higher in Asia and Africa than in Europe. In Asia approximately 10% of patients with a diagnosis of HCC die due to rupture each year. Spontaneous rupture is the third most common cause of death due to HCC after tumor progression and liver failure. The diagnosis of rupture in patients without history of cirrhosis or HCC may be difficult. The most common symptom of ruptured HCC is abdominal pain (66-100%). Shock at presentation can be seen in 33-90% of cases; abdominal distension is reported in 33%. Abdominal paracentesis documenting hemoperitoneum is a reliable test to provisionally diagnose rupture of HCC, it can be seen in up to 86% of clinically suspected cases. The diagnoses can be confirmed by computed tomography scan or ultrasonography, or both in 75% of cases. Careful pre-treatment evaluation is essential to decide the best treatment option. Management of ruptured HCC involves multi-disciplinary care where hemostasis remains a primary concern. Earlier studies have reported a mortality rate of 25-75% in the acute phase of ruptured HCC. However, recent studies have reported a significant decrease in the incidence of mortality. There is also a decrease in the incidence of ruptured HCC due to improved surveillance and early detection of HCC. Transarterial Embolization is the least invasive method to effectively induce hemostasis in the acute stage with a success rate of 53-100%. Hepatic resection in the other hand has the advantage of achieving hemostasis and in the same go offers a potentially curative resection in selected patients.
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Affiliation(s)
- Srimanta K. Sahu
- Department of Hepatology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Yogesh K. Chawla
- Department of Hepatology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Radha K. Dhiman
- Department of Hepatology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Virendra Singh
- Department of Hepatology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ajay Duseja
- Department of Hepatology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sunil Taneja
- Department of Hepatology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Naveen Kalra
- Department of Radio Diagnosis, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ujjwal Gorsi
- Department of Radio Diagnosis, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Ren A, Luo S, Ji L, Yi X, Liang J, Wang J, Wan S. Peritoneal metastasis after emergency hepatectomy and delayed hepatectomy for spontaneous rupture of hepatocellular carcinoma. Asian J Surg 2018; 42:464-469. [PMID: 30420157 DOI: 10.1016/j.asjsur.2018.09.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 08/05/2018] [Accepted: 09/14/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Delayed hepatectomy is the preferred approach for spontaneous rupture of resectable hepatocellular carcinoma (HCC). However, delayed surgery for ruptured HCC may increase the risk of peritoneal metastasis. METHODS A retrospective analysis was conducted on the pooled data obtained from 44 HCC patients with spontaneously ruptured hemorrhage, These patients were divided into emergency group and delayed group. Perioperative events, overall survival (OS) and disease-free survival (DFS) rates, and the incidence of recurrent and metastatic disease were compared between these two groups. RESULTS Median survival time was 17.0 months in the emergency group vs. 28.0 months in the delayed group. In the emergency group, the 6-month, 1-year and 3-year OS rates were 58.8%, 57.6% and 11.5%. In the delayed hepatectomy group, the 6-month, 1-year and 3-year OS rates of were 84.3%, 77.5% and 37.8%. The incidence of peritoneal metastasis was higher in delayed group than in the emergency group, but the difference was not statistically significant (40.7% vs. 35.3%, P > 0.05). CONCLUSION Delayed hepatectomy warrants better short-term prognosis, compared with emergency hepatectomy, for HCC patients with spontaneously ruptured hemorrhage. Delayed hepatectomy does not increase the possibility of postoperative peritoneal metastasis.
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Affiliation(s)
- Ao Ren
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, PR China
| | - Shiqiao Luo
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, PR China.
| | - Lei Ji
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, PR China
| | - Xin Yi
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, PR China
| | - Jinyao Liang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, PR China
| | - Jianming Wang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, PR China
| | - Shunyuan Wan
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, PR China
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Moris D, Chakedis J, Sun SH, Spolverato G, Tsilimigras DI, Ntanasis-Stathopoulos I, Spartalis E, Pawlik TM. Management, outcomes, and prognostic factors of ruptured hepatocellular carcinoma: A systematic review. J Surg Oncol 2017; 117:341-353. [DOI: 10.1002/jso.24869] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 09/12/2017] [Indexed: 12/15/2022]
Affiliation(s)
- Demetrios Moris
- Department of Surgery; The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute; Columbus Ohio
| | - Jeffery Chakedis
- Department of Surgery; The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute; Columbus Ohio
| | - Steven H. Sun
- Department of Surgery; The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute; Columbus Ohio
| | - Gaya Spolverato
- Department of Surgery; The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute; Columbus Ohio
| | - Diamantis I. Tsilimigras
- Department of Therapeutics; Alexandra General Hospital; National and Kapodistrian University of Athens; Athens Greece
| | - Ioannis Ntanasis-Stathopoulos
- Department of Therapeutics; Alexandra General Hospital; National and Kapodistrian University of Athens; Athens Greece
| | - Eleftherios Spartalis
- Laboratory of Experimental Surgery and Surgical Research; National and Kapodistrian University of Athens; Athens Greece
| | - Timothy M. Pawlik
- Department of Surgery; The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute; Columbus Ohio
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Abstract
BACKGROUND Hepatocellular carcinoma is an uncommon complication described in patients with Budd-Chiari syndrome. CASE CHARACTERISTICS A 12-year-old boy with Budd-Chiari syndrome, who was earlier treated with Transjugular intrahepatic porto-systemic shunt (TIPS), presented with acute onset hemoperitoneum and hypotension. OUTCOME It was diagnosed to be a case of ruptured hepatocellular carcinoma. MESSAGE Successful TIPS may not prevent the development of hepatocellular carcinoma, and children with Budd Chiari syndrome should be monitored for the same.
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Kishore S, Friedman T, Madoff DC. Update on Embolization Therapies for Hepatocellular Carcinoma. Curr Oncol Rep 2017; 19:40. [PMID: 28421483 DOI: 10.1007/s11912-017-0597-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW The purpose of the review is to summarize the latest applications for embolotherapy in the management of patients with HCC according to BCLC stage. RECENT FINDINGS While traditionally reserved for patients with unresectable HCC and stage B disease, there is an important role for embolization therapies in earlier stage patients as an adjunct to ablation, bridging, or downstaging therapy, as a means to improve safety of resection, and potentially as an arterial ablative option in the case of radioembolization. Newer applications of radioembolization such as radiation segmentectomy have the potential to provide cure in localized unifocal disease, and transarterial chemoembolization-portal vein embolization and radiation lobectomy may provide a combination of treatment and future liver remnant hypertrophy for planned hepatic resection. There is also an increasing role for embolization in the treatment of stage C disease, and recent data suggest it can be used in combination with sorafenib with the potential for survival benefit over sorafenib alone, even in the case of portal vein tumor thrombus. Embolization therapies play an increasingly important role in patients with BCLC stage A-C hepatocellular carcinoma. While different therapies may be offered on a patient-specific basis, there are limited prospective RCT data to support superiority of one technique over another.
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Affiliation(s)
- Sirish Kishore
- Department of Radiology, Division of Interventional Radiology, New York Presbyterian Hospital/Weill Cornell Medical Center, 525 East 68th Street P-518, New York, NY, 10065, USA
| | - Tamir Friedman
- Department of Radiology, Division of Interventional Radiology, New York Presbyterian Hospital/Weill Cornell Medical Center, 525 East 68th Street P-518, New York, NY, 10065, USA
| | - David C Madoff
- Department of Radiology, Division of Interventional Radiology, New York Presbyterian Hospital/Weill Cornell Medical Center, 525 East 68th Street P-518, New York, NY, 10065, USA.
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Bertacco A, D'Amico F, Romano M, Finotti M, Vitale A, Cillo U. Liver radiofrequency ablation as emergency treatment for a ruptured hepatocellular carcinoma: a case report. J Med Case Rep 2017; 11:54. [PMID: 28245861 PMCID: PMC5331708 DOI: 10.1186/s13256-017-1199-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 01/03/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Hemoperitoneum is a possible complication of hepatocellular carcinoma that may require emergency surgery as an alternative to radiological locoregional therapies. CASE PRESENTATION We present a case report of a 78-year-old white man with alcoholic-related cirrhosis and a multifocal hepatocellular carcinoma. An abdominal computed tomography scan showed multiple and bilateral foci of bleeding from broken liver cancer. He was urgently transferred from our radiology unit to our operating room for massive hemoperitoneum. A middle line laparotomy detected a massive hemoperitoneum. His liver was cirrhotic and completely subverted by a tumor; there were two spontaneous bleeding lacerations on segments II and IV, which were uncontrollable with conventional hemostatic techniques. Therefore, it was decided to carry out the coagulation of the multiple vascular afferents of each single mass by means of radiofrequency ablation cycles performed circumferentially on both nodules for a total of 40 minutes. Hemostasis was achieved; the radiofrequency ablation controlled the bleeding from his ruptured hepatocellular carcinoma. He was transferred to our intensive care unit for postoperative monitoring in terms of hemodynamic stability. On postoperative day 2 he was discharged from our intensive care unit. CONCLUSIONS Multifocal bleeding hepatocellular carcinoma still has an extremely high mortality. The angiographic control of multiple bilateral bleeding lesions can be extremely difficult and can be contraindicated by the location of the lesions and by the overall clinical condition of the patient. In this case, treatment with radiofrequency ablation has proven to be effective in the control of multiple and bilateral hepatic lesions. This particular technique allowed us to attack the lesion at the level of the vascular pedicle in order to control the bleeding.
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Affiliation(s)
- Alessandra Bertacco
- Department of Surgery, Oncology and Gastroenterology (DISCOG), Hepatobiliary Surgery and Liver Transplantation, Padua University, Padua, Italy.,Department of Surgery, Division of Transplantation and Immunology, Yale University, New Haven, Connecticut, USA
| | - Francesco D'Amico
- Department of Surgery, Oncology and Gastroenterology (DISCOG), Hepatobiliary Surgery and Liver Transplantation, Padua University, Padua, Italy. .,Department of Surgery, Division of Transplantation and Immunology, Yale University, New Haven, Connecticut, USA.
| | - Maurizio Romano
- Department of Surgery, Oncology and Gastroenterology (DISCOG), Hepatobiliary Surgery and Liver Transplantation, Padua University, Padua, Italy
| | - Michele Finotti
- Department of Surgery, Oncology and Gastroenterology (DISCOG), Hepatobiliary Surgery and Liver Transplantation, Padua University, Padua, Italy
| | - Alessandro Vitale
- Department of Surgery, Oncology and Gastroenterology (DISCOG), Hepatobiliary Surgery and Liver Transplantation, Padua University, Padua, Italy
| | - Umberto Cillo
- Department of Surgery, Oncology and Gastroenterology (DISCOG), Hepatobiliary Surgery and Liver Transplantation, Padua University, Padua, Italy
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Hao B, Guo W, Luo NN, Fu H, Chen HJ, Zhao L, Wu H, Sun L. Metabolic imaging for guidance of curative treatment of isolated pelvic implantation metastasis after resection of spontaneously ruptured hepatocellular carcinoma: A case report. World J Gastroenterol 2016; 22:9242-9246. [PMID: 27895412 PMCID: PMC5107606 DOI: 10.3748/wjg.v22.i41.9242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 07/09/2016] [Accepted: 08/01/2016] [Indexed: 02/06/2023] Open
Abstract
Spontaneous rupture of hepatocellular carcinoma (HCC) is a life-threatening complication and its prognosis is significantly poor because of the high recurrence rate after initial hepatectomy. Resection of isolated extrahepatic metastasis of HCC has been advocated to obtain a possibility of long-term survival. However, it is a challenge for clinicians to detect implantation metastasis of spontaneously ruptured HCC. Accurate re-staging plays the most important role in making a decision on isolated metastasis resection. 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) is useful in detecting intra-abdominal implantation metastasis from a variety of malignancies and shows superior accuracy to conventional imaging modalities in determining the location of metastasis. We present one patient with a new isolated pelvic implantation metastasis detected by 18F-FDG PET/CT and pathologically confirmed by PET/CT-guided percutaneous biopsy, who had a history of resection of spontaneously ruptured HCC two years ago. The patient’s condition was stable at the 6-mo follow-up after resection of the isolated pelvic metastasis.
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Spontaneous Rupture of Hepatic Metastasis from Pancreatic Adenocarcinoma. Case Rep Oncol Med 2016; 2016:6968534. [PMID: 27597912 PMCID: PMC5002469 DOI: 10.1155/2016/6968534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 07/12/2016] [Accepted: 07/14/2016] [Indexed: 01/06/2023] Open
Abstract
A 58-year-old man with advanced-stage pancreatic adenocarcinoma presented with fatigue and dyspnea. Examination revealed tachycardia (102 b/min) with mild tenderness in right upper quadrant. His hemoglobin (Hb) was 7.9 g/dL (10 days prior to presentation 12.2 g/dL), International normalized ratio (INR), platelet count was normal, and the stool guaiac test was negative. On admission, abdominal computed tomography (CT) scan showed hepatic metastatic lesion with a rupture and hemoperitoneum communicating to the subdiaphragmatic space. This rapid progression of anemia along with presenting symptoms and CT imaging were attributed to diagnosis of spontaneous rupture of liver metastasis from pancreatic adenocarcinoma. Patient received blood transfusion and hemoglobin was monitored in successive intervals. His general condition and anemia improved with conservative management and he was discharged in 3 days. Repeated CT after 4 months showed resolving hemoperitoneum and stable hemoglobin levels. The patient deceased 9 months after being diagnosed. A literature search revealed limited data regarding the incidence and management of spontaneous rupture of metastatic lesion secondary to pancreatic adenocarcinoma which has been managed conservatively and thus we are reporting our experience.
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37
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Wu PZ, Zhou J, Zhang YW. Gelatin sponge microparticles for the treatment of the spontaneous rupture of hepatocellular carcinoma hemorrhage. Exp Ther Med 2016; 12:2201-2207. [PMID: 27698712 DOI: 10.3892/etm.2016.3573] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 06/06/2016] [Indexed: 12/12/2022] Open
Abstract
Spontaneous rupture of hepatocellular carcinoma hemorrhage is life-threatening. The aim of the present study was to retrospectively analyze the effect of gelatin sponge microparticles (GSMs) of various diameters on the treatment of spontaneous rupture of hepatocellular carcinoma hemorrhage. GSMs serve as embolization agents by transcatheter arterial chemoembolization (TACE), and the current study analyzed their safety and efficacy. Data from a total of 13 cases of spontaneous rupture of hepatocellular carcinoma hemorrhage, who were treated with GSM-TACE at the Affiliated Zhongshan Hospital of Dalian University (Dalian, China) between August 2010 and June 2014, were collected. Post-operative complications were classified according to the National Cancer Institute Common Terminology Criteria. Review computed tomography was conducted 1, 3 and 6 months after GSM-TACE treatment in order to determine the occurrence of re-bleeding; the tumor response was evaluated based on the Modified Response Evaluation Criteria In Solid Tumors and the expression levels of α-feroprotein. The patients were followed-up for 1-6 months (average, 5.15±1.67 months). Following GSM-TACE treatment, 13 cases reached successful hemostasis without technical complications. The survival rates 1, 3 and 6 months after treatment were 76.9 (10/13), 61.5 (8/13) and 53.8% (7/13), respectively; the objective response rates were 61.6, 53.9 and 38.5%, respectively. The primary post-operative complications were pain (100%), nausea and vomiting (69.2%), and fever (53.8%). Among the 13 patients, 2 cases underwent surgical excision 10 and 30 days after GSM-TACE, and 1 case experienced re-bleeding 3 months after treatment, after which the patient received a second treatment with TACE and successful achieved hemostasis. In conclusion, GSM-TACE of various diameters is a safe and effective method in the treatment of spontaneous rupture of hepatocellular carcinoma hemorrhage. GSM-TACE is able to achieve immediate hemostasis and improves the survival rate of patients, thus creating favorable conditions for follow-up treatment.
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Affiliation(s)
- Pu Zhao Wu
- Department of Interventional Therapy, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning 116001, P.R. China
| | - Jun Zhou
- Department of Interventional Therapy, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning 116001, P.R. China
| | - Yue Wei Zhang
- Department of Interventional Therapy, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning 116001, P.R. China
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Zhong F, Cheng XS, He K, Sun SB, Zhou J, Chen HM. Treatment outcomes of spontaneous rupture of hepatocellular carcinoma with hemorrhagic shock: a multicenter study. SPRINGERPLUS 2016; 5:1101. [PMID: 27468402 PMCID: PMC4947465 DOI: 10.1186/s40064-016-2762-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 07/05/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND Spontaneous rupture is one of the most fatal complications of HCC. The incidence of HCC still remains a significant health problem in Eastern Asia. Many studies have shown that the in-hospital or 30-day mortality rates are as high as 25-100 %. It is often difficult to stratify these patients based on clinical manifestations and biochemical data, for deciding on an appropriate treatment strategy, especially when the patient's hemodynamic status is unstable. This study aimed to explore the clinical outcomes of treatment of spontaneously ruptured hepatocellular carcinoma with hemorrhagic shock. METHODS One hundred and sixty two patients with hemorrhagic shock secondary to spontaneous rupture of hepatocellular carcinoma were included in this retrospective study. The therapeutic methods included conservative treatment, transcatheter arterial embolization (TAE) and hepatectomy. The outcomes in terms of 30 day and 1 year survival were analyzed. RESULTS Thirty five (21.6 %) received only conservative management, TAE was performed in 48 (29.6 %) and partial hepatectomy (emergency and staged) in 106 (65.4 %) patients. The 30-day survival rate was lower in patients receiving conservative treatment (8.6 %) than in those receiving either hepatectomy or TAE (88.2 %; P < 0.001). Conservative treatment was associated with poorer long-term survival (0 % at 1 year) when compared to those receiving either hepatectomy or TAE (54.3 % at 1 year; P < 0.001). The survival rates at 30 days and 1 year were 92.5 % and 59.4 % for the patients who underwent hepatectomy, which were significantly higher (66.7 and 28.6 % respectively) than those receiving TAE alone (P = 0.003 and P = 0.009, respectively). Multivariate Cox-regression analysis showed that hepatectomy and TAE were significant protective factors for survival as compared with conservative treatment (all P < 0.01). CONCLUSIONS Partial hepatectomy, tended to provide better survival than transcatheter arterial embolization alone or conservative treatment in the management of patients with hemorrhagic shock secondary to spontaneous rupture of hepatocellular carcinoma.
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Affiliation(s)
- Feng Zhong
- Department of Hepatobiliary Surgery, Nanfang Hospital, Southern Medical University, No. 1838, North Guangzhou Avenue, Guangzhou, 510515 Guangdong Province China ; Department of Hepatobiliary Surgery, Shenzhen Hospital of Southern Medical University, Shenzhen, 518100 Guangdong Province China
| | - Xin-Sheng Cheng
- Department of Hepatobiliary Surgery, Nanfang Hospital, Southern Medical University, No. 1838, North Guangzhou Avenue, Guangzhou, 510515 Guangdong Province China
| | - Kun He
- Department of Hepatobiliary Surgery, Nanfang Hospital, Southern Medical University, No. 1838, North Guangzhou Avenue, Guangzhou, 510515 Guangdong Province China
| | - Shi-Bo Sun
- Department of Hepatobiliary Surgery, Nanfang Hospital, Southern Medical University, No. 1838, North Guangzhou Avenue, Guangzhou, 510515 Guangdong Province China
| | - Jie Zhou
- Department of Hepatobiliary Surgery, Nanfang Hospital, Southern Medical University, No. 1838, North Guangzhou Avenue, Guangzhou, 510515 Guangdong Province China
| | - Hai-Ming Chen
- Department of General Surgery, Jiangmen People's Hospital, Jiangmen, 529000 Guangdong Province China
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Chan W, Hung C, Pan K, Lui K, Huang Y, Lin S, Lin Y, Wu T, Yu M. Impact of spontaneous tumor rupture on prognosis of patients with T4 hepatocellular carcinoma. J Surg Oncol 2016; 113:789-95. [PMID: 27062288 PMCID: PMC5071691 DOI: 10.1002/jso.24245] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 03/21/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND OBJECTIVES Compare the outcomes of three groups of patients with T4 hepatocellular carcinoma (HCC): tumor rupture with shock (RS group), tumor rupture without shock (R group), and no tumor rupture (NR group). MATERIALS AND METHODS We retrospectively reviewed 221 patients with T4 HCC from 2010 to 2012. The clinical background and prognosis were analyzed. RESULTS Overall in-hospital mortality rate was 18.1%; overall median survival time was 4 months. The NR group were more likely to have multiple and infiltrative tumors (P < 0.001). Relative to the NR group, the R + RS group had better survival rates at 6 months (49.2% vs. 32.2%), 1 year (35.3% vs. 21.0%), 3 years (22.5% vs. 11.0%), and 5 years (17.7% vs. 5.5%) (P = 0.010). Patients in the RS group had a higher in-hospital mortality rate, but significantly better long-term survival than the NR and R group (P < 0.001). Multivariate analysis indicated that Child-Pugh class B or C, presence of portal venous thrombosis, and absence of shock were significantly associated with poor survival. CONCLUSION Patients with tumor rupture and shock had worse in-hospital survival. However, patients without decompensated liver cirrhosis and portal venous thrombosis, and eligible for curative treatment had favorable long-term outcome. J. Surg. Oncol. 2016;113:789-795. © 2016 The Authors. Journal of Surgical Oncology Published by Wiley Periodicals, Inc.
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Affiliation(s)
- Wen‐Hui Chan
- Department of Medical Imaging and InterventionChang Gung Memorial Hospital, Linkou, Chang Gung UniversityTaoyuanTaiwan
| | - Chien‐Fu Hung
- Department of Medical Imaging and InterventionChang Gung Memorial Hospital, Linkou, Chang Gung UniversityTaoyuanTaiwan
| | - Kuang‐Tse Pan
- Department of Medical Imaging and InterventionChang Gung Memorial Hospital, Linkou, Chang Gung UniversityTaoyuanTaiwan
| | - Kar‐Wai Lui
- Department of Medical Imaging and InterventionChang Gung Memorial Hospital, Linkou, Chang Gung UniversityTaoyuanTaiwan
| | - Yu‐Ting Huang
- Department of Medical Imaging and InterventionChang Gung Memorial Hospital, Linkou, Chang Gung UniversityTaoyuanTaiwan
| | - Shen‐Yen Lin
- Department of Medical Imaging and InterventionChang Gung Memorial Hospital, Linkou, Chang Gung UniversityTaoyuanTaiwan
| | - Yang‐Yu Lin
- Department of Medical Imaging and InterventionChang Gung Memorial Hospital, Linkou, Chang Gung UniversityTaoyuanTaiwan
| | - Tsung‐Han Wu
- Division of General SurgeryDepartment of Surgery, Chang Gung Memorial Hospital, Linkou, Chang Gung UniversityTaoyuanTaiwan
| | - Ming‐Chin Yu
- Division of General SurgeryDepartment of Surgery, Chang Gung Memorial Hospital, Linkou, Chang Gung UniversityTaoyuanTaiwan
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Damage Control Surgery for Hepatocellular Cancer Rupture in an Elderly Patient: Survival and Quality of Life. Case Rep Emerg Med 2015; 2015:536029. [PMID: 26504604 PMCID: PMC4609419 DOI: 10.1155/2015/536029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Accepted: 09/21/2015] [Indexed: 12/14/2022] Open
Abstract
Spontaneous rupture of hepatocellular carcinoma (HCC) is a rare emergency condition with high mortality rate. Successful management depends on patients' hemodynamic condition upon presentation and comorbidities, correct diagnosis, HCC status, liver function, and future liver remnant, as well as available sources. There is still a debate in the literature concerning the best approach in this devastating complication. Nevertheless, the primary goal should be a definitive bleeding arrest. In most cases, patients with spontaneous rupture of HCC present with hemodynamic instability, due to hemoperitoneum, necessitating an emergency treatment modality. In such cases, transcatheter arterial embolization (TAE) should be the treatment of choice. Emergency liver resection is an option when TAE fails or in cases with preserved liver function and limited tumors. Otherwise, damage control strategies, as in liver trauma, are a reasonable alternative. We report a case of an elderly patient with hemoperitoneum and hypovolemic shock from spontaneous rupture of undiagnosed HCC, who was treated successfully by emergency surgery and damage control approach.
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Zhang DZ, Zhang K, Wang XP, Cai H. Patients with spontaneously ruptured hepatocellular carcinoma benefit from staged surgical resection after successful transarterial embolization. Asian Pac J Cancer Prev 2015; 16:315-9. [PMID: 25640372 DOI: 10.7314/apjcp.2015.16.1.315] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Surgical resection of spontaneously ruptured hepatocellular carcinoma (HCC) after successful transarterial embolization (TAE) remains controversial. The aim of this study was to investigate its efficacy in a series of cases. MATERIALS AND METHODS We retrospectively examined ruptured HCC cases from Jan 2000 to Dec 2008; all of these 126 cases received TAE as the initial therapy. Subsequently, 74 cases received staged surgical resection, and the remaining 52 cases underwent repeated TACE. The baseline demographic data, tumor characteristics, and long term survival were recorded and compared. RESULTS The demographic and baseline characteristics were comparable between the hepatic resection and TACE groups; furthermore, no significant difference in the tumor characteristics was detected between the two groups. The differences in in-hospital, 30- day and 90-day mortality between the two groups were not significant (P>0.05). However, the 1-, 3-, and 5-year overall survival rates were 85.1%, 63.5%, and 37.8%, respectively, in the hepatic resection group, which were significantly higher than those in the TACE group (69.2%, 46.2%, and 17.3%, respectively, P=0.004). Univariate and multivariate analyses indicated that these patients benefitted from hepatic resection compared with TACE with respect to long-term outcomes. CONCLUSIONS Staged hepatic resection after TAE is an effective treatment that results in superior long-term survival to repeated TACE.
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Affiliation(s)
- Dong-Zhi Zhang
- Emergency Department, Gansu Provincial Hospital, Lanzhou, China E-mail :
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Yasuda S, Nomi T, Hokuto D, Yamato I, Obara S, Yamada T, Kanehiro H, Nakajima Y. Huge hepatocellular carcinoma with multiple intrahepatic metastases: An aggressive multimodal treatment. Int J Surg Case Rep 2015; 16:44-7. [PMID: 26413921 PMCID: PMC4643438 DOI: 10.1016/j.ijscr.2015.09.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 09/09/2015] [Accepted: 09/09/2015] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Huge hepatocellular carcinoma (HCC) possesses a potential risk for spontaneous rupture, which leads to a life-threatening complication with a high mortality rate. In addition, a large HCC is frequently accompanied by intrahepatic metastases. PRESENTATION OF CASE We describe, the case of a 74-year-old woman with a huge extrahepatically expanding HCC with multiple intrahepatic metastases who was treated by liver resection with repeated transcatheter arterial chemoembolization (TACE). To prevent tumor rupture or bleeding, we performed right hepatectomy. After the operation, TACE was applied for multiple intrahepatic metastases in the remnant liver. Furthermore, the elevated protein induced vitamin K absence (PIVKA II) level had decreased to limits within the normal range. Three months after the first TACE, computed tomography revealed several recurrences in the liver. TACE was applied for the second and third time and the tumors were well controlled. DISCUSSION Although, liver resection is occasionally performed for patients with huge HCC to avoid spontaneous tumor rupture, only surgical approach might not be sufficient for such advanced HCC. To achieve long-term survival, it is necessary to control the residual intrahepatic tumors. We could control multiple intrahepatic metastases with repeated TACEs after hepatectomy. CONCLUSION Multimodal treatment involving hepatectomy and TACE might be a good treatment strategy for patients with huge HCC with multiple intrahepatic metastases if the tumors are localized in the liver without distant or peritoneal metastasis.
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Affiliation(s)
- Satoshi Yasuda
- Department of Surgery, Nara Medical University, 840 Shijo-cho Kashihara-shi, 634-8522 Nara, Japan
| | - Takeo Nomi
- Department of Surgery, Nara Medical University, 840 Shijo-cho Kashihara-shi, 634-8522 Nara, Japan.
| | - Daisuke Hokuto
- Department of Surgery, Nara Medical University, 840 Shijo-cho Kashihara-shi, 634-8522 Nara, Japan
| | - Ichiro Yamato
- Department of Surgery, Nara Medical University, 840 Shijo-cho Kashihara-shi, 634-8522 Nara, Japan
| | - Shinsaku Obara
- Department of Surgery, Nara Medical University, 840 Shijo-cho Kashihara-shi, 634-8522 Nara, Japan
| | - Takatsugu Yamada
- Department of Surgery, Nara Medical University, 840 Shijo-cho Kashihara-shi, 634-8522 Nara, Japan
| | - Hiromichi Kanehiro
- Department of Surgery, Nara Medical University, 840 Shijo-cho Kashihara-shi, 634-8522 Nara, Japan
| | - Yoshiyuki Nakajima
- Department of Surgery, Nara Medical University, 840 Shijo-cho Kashihara-shi, 634-8522 Nara, Japan
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Barosa R, Figueiredo P, Fonseca C. Acute Anemia in a Patient With Hepatocellular Carcinoma. HCC Rupture With Intraperitoneal Hemorrhage. Gastroenterology 2015; 149:e3-4. [PMID: 26231603 DOI: 10.1053/j.gastro.2014.12.055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 12/29/2014] [Indexed: 01/19/2023]
Affiliation(s)
- Rita Barosa
- Department of Gastroenterology, Hospital Garcia de Orta, Almada, Portugal
| | - Pedro Figueiredo
- Department of Gastroenterology, Hospital Garcia de Orta, Almada, Portugal
| | - Cristina Fonseca
- Department of Gastroenterology, Hospital Garcia de Orta, Almada, Portugal
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Hemostastic embolization in oncology. Diagn Interv Imaging 2015; 96:807-21. [DOI: 10.1016/j.diii.2015.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 06/10/2015] [Indexed: 02/07/2023]
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Han XJ, Su HY, Shao HB, Xu K. Prognostic factors of spontaneously ruptured hepatocellular carcinoma. World J Gastroenterol 2015; 21:7488-7494. [PMID: 26139994 PMCID: PMC4481443 DOI: 10.3748/wjg.v21.i24.7488] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 01/29/2015] [Accepted: 02/11/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the prognostic factors in patients with spontaneously ruptured hepatocellular carcinoma (HCC).
METHODS: Seventy-nine patients experiencing spontaneous rupture of HCC between April 2004 and August 2014 were enrolled in this study. The clinical features, treatment modalities and outcomes were reviewed. The statistical methods used in this work included univariate analysis, Kaplan-Meier survival analysis with log-rank tests, and multivariate analysis using a Cox regression hazard model.
RESULTS: Of the 79 patients with HCC rupture, 17 (21.5%) underwent surgery, 32 (40.5%) underwent transarterial embolization (TAE), and 30 (38%) received conservative treatment. The median survival time was 125 d, and the mortality rate at 30 d was 27.8%. Multivariate analysis revealed that lesion length (HR = 1.46, P < 0.001), lesion number (HR = 1.37, P = 0.042), treatment before tumor rupture (HR = 4.36, P = 0.019), alanine transaminase levels (HR = 1.0, P = 0.011), bicarbonate levels (HR = 1.18, P < 0.001), age (HR = 0.96, P = 0.026), anti-tumor therapy during the follow-up period (HR = 0.21, P = 0.008), and albumin levels (HR = 0.89, P = 0.010) were independent prognostic factors of survival after HCC rupture. The Barcelona-Clinic Liver Cancer (BCLC) stage was also an important prognostic factor; the median survival times for BCLC stages A, B and C were 251, 175 and 40 d, respectively (P < 0.001).
CONCLUSION: Anti-tumor therapy during the follow-up period, without a history of anti-tumor therapy prior to HCC rupture, small tumor length and number, and early BCLC stage are the most crucial predictors associated with satisfactory overall survival. Other factors play only a small role in overall survival.
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Huang KY, Tsai MC, Yeh CB, Ho SW. Spontaneous Rupture of Hepatocellular Carcinoma Mimicking ST-Segment Elevation Myocardial Infarction. J Emerg Med 2015; 48:e123-5. [PMID: 25843925 DOI: 10.1016/j.jemermed.2014.12.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Accepted: 12/21/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Several medical conditions that mimic ST-elevation myocardial infarction (STEMI) have been reported previously, but acute abdominal disease mimicking STEMI is rare. CASE REPORT We report on a 72-year-old man who presented to the emergency department (ED) with epigastric pain. Meanwhile, STEMI with shock developed. Anticoagulation medication and emergent percutaneous coronary intervention (PCI) were arranged in a timely manner. However, hepatocellular carcinoma (HCC) rupture was the true cause of the ST-segment elevation. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case report highlights the fact that acute myocardial infarction is not the only cause of ST-segment elevation. HCC rupture should be one of the differential diagnoses.
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Affiliation(s)
- Kai-Yi Huang
- Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan and Department of Emergency Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Ming-Che Tsai
- Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan and Department of Emergency Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Chao-Bin Yeh
- Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan and Department of Emergency Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Sai-Wai Ho
- Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan and Department of Emergency Medicine, Chung Shan Medical University, Taichung, Taiwan
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Yang H, Chen K, Wei Y, Liu F, Li H, Zhou Z, Li B. Treatment of spontaneous ruptured hepatocellular carcinoma: A single-center study. Pak J Med Sci 2014; 30:472-6. [PMID: 24948961 PMCID: PMC4048488 DOI: 10.12669/pjms.303.4001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Revised: 02/27/2014] [Accepted: 03/02/2014] [Indexed: 02/07/2023] Open
Abstract
Objectives: Spontaneous rupture of hepatocarcinoma (HCC) is a fatal complication of advanced HCC and is associated with poor prognosis. However, there is no consensus on the best approach to treat hemoperitoneum due to ruptured HCC. In this paper, we evaluate and discuss the outcomes of different treatment methods employed at our center for ruptured HCC. Methods: We reviewed the medical records of 132 patients diagnosed with ruptured HCC at our hospital from January 2003 to December 2012 and evaluated and compared the outcomes of five treatment methods for ruptured HCC: conservative treatment, surgical hemostasis, transarterial embolization (TAE), and one- and two-stage resections. Results: There was no significant difference in the median survival time between the conservative treatment and surgical hemostasis groups. Patients in the TAE alone group had a better prognosis than those in the conservative treatment and surgical hemostasis groups. The survival time of the tumor resection group was obviously better than that of the conservative treatment, surgical hemostasis, and TAE alone groups, but no significant difference was observed between the one-stage and two-stage resection groups. Conclusions: One-stage hepatectomy is a better option for patients with preserved liver function, whereas TAE is a better option for those with poorly preserved liver function.
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Affiliation(s)
- Hanteng Yang
- Hanteng Yang, Department of Liver Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Kefei Chen
- Kefei Chen, Department of Liver Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yongang Wei
- Yongang Wei, Department of Liver Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Fei Liu
- Fei Liu, Department of Liver Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Hongyu Li
- Hongyu Li, Department of Liver Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Zhipeng Zhou
- Zhipeng Zhou, Department of Liver Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Bo Li
- Bo Li, Department of Liver Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
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