Hepatectomy for spontaneous rupture of hepatocellular carcinoma without portal triad clamping

Snip-electrocoagulation technique versus clamp-crashing technique for parenchyma transection in liver resection: a pilot study

Background

Nowadays, much effort has been made to optimize the technique for liver parenchyma transection to reduce intrasurgical hemorrhage and complications. Here we intent to introduce a novel method for sharp liver parenchyma transection using scissors and bipolar electrocoagulator (named the snip-electrocoagulation technique, SET) and compare it with the classical clamp-crushing technique (CCT).

Methods

In this retrospective study, 98 patients were divided into either the SET group or the CCT group. The total inflow occlusion time, total surgery time, intrasurgical blood loss and transfusion, morbidity, mortality, hospital stay, and the narrowest tumor-free margins were compared.

Results

Background characteristics in the two groups were comparable, and the differences of total inflow occlusion time (median 25 vs. 27 minutes), total surgery time (median 182.5 vs. 190 minutes), blood transfusion amount (median value 0 in both groups), postoperative hospital stay (median 7 vs. 8 days), and overall complication rate (16% vs. 31.2%, P>0.05) were not statistically significant. However, the SET group yielded less intrasurgical blood loss (median 200 vs. 300 mL), and better tumor-free margins (13.69±2.99 vs. 10.76±3.31 mm; mean ± SD; P<0.05).

Conclusions

SET is a safe method for sharp parenchyma transection in liver resection when compared with the classical CCT, considering the similar morbidity and mortality, along with the decreased intrasurgical blood loss. More importantly, SET can be adopted when the tumors are located close to the intrahepatic vessels and the tumor-free margins are expected to be limited.

Transjugular intrahepatic portal shunt in the treatment of portal hypertension due to cirrhosis: single center experience

Aim

To investigate clinical efficacy of transjugular intrahepatic portal shunt (TIPS) for the treatment of cirrhotic portal hypertension.

Methods

71 cases of patients with cirrhotic portal hypertension and esophageal and gastric variceal bleeding hospitalized from January 2014 to June 2017 were enrolled and treated with TIPS. The change of portal pressure and serum biochemical indexes before and after TIPS were compared, and re-hemorrhage rate, ascites incidence, complications, and survival rate were calculated.

Results

71 patients (male/female 47/24, aged 29–77 years, average 48.9 ± 9.8 years) with cirrhotic portal hypertension received TIPS. The success rate of TIPS was 93% (66/71). During 1–24 months (mean 12.5 ± 7 months) follow-up of 66 patients, 61 cases survived and 5 cases died. The portal pressure decreased significantly from 40.48 ± 3.15 cmH2O to 23.59 ± 4.41 cmH2O after TIPS (P < 0.05). During the follow-up, the incidence of hepatic encephalopathy was 12.1%, the incidence of re-hemorrhage was 18.2%, and there were 4 cases of stent dysfunction, with 1 case of bare stent and 3 cases of dual stent.

Conclusion

TIPS is an effective procedure for the treatment of cirrhotic portal hypertension complications, since it can reduce portal pressure and significantly alleviate ascites. Liver function is impaired in short-term after TIPS, but TIPS has no significant effect on liver function in middle-term.

Retrospective analysis of transcatheter arterial chemoembolization treatment for spontaneously ruptured hepatocellular carcinoma

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.