title: Staged hepatectomy after emergency transcatheter arterial embolization for ruptured hepatocellular carcinoma.
abstract: BACKGROUND
  Staged hepatectomy after emergency transcatheter arterial embolization (TAE) has been advocated in ruptured hepatocellular carcinoma (HCC). However, there have been no reports of clinical series of this strategy. The purpose of this study was to evaluate the protocol of this therapeutic strategy.
  
  
  METHODS
  Sixteen patients with suspected rupture of HCC were included in the study. After emergency TAE, tumor resectability was assessed, followed by staged hepatectomy or repeated TAE. The patients were reevaluated with regard to rupture of HCCs.
  
  
  RESULTS
  Primary hemostasis was achieved successfully in all patients. Eleven patients were finally judged to have experienced HCC rupture. Seven of them underwent staged hepatectomy; the other four underwent repeated TAE because their tumors were considered unresectable. Survival time tended to be longer, but not to a significant extent, in patients who underwent hepatectomy (range, 139 to 1527 days; median, 375 days) than in those treated by TAE alone (range, 43 to 1317 days; median, 158 days).
  
  
  CONCLUSIONS
  Staged hepatectomy after TAE is a rational treatment for patients with ruptured HCC. Although TAE is highly effective for initial hemostasis, hepatectomy appears to provide better long-term survival.
authors.affiliation: First Department of Surgery, Shinshu University School of Medicine Matsumoto, Japan.
authors.forename: R
authors.initials: R
authors.lastname: Shimada
authors.forename: H
authors.initials: H
authors.lastname: Imamura
authors.forename: M
authors.initials: M
authors.lastname: Makuuchi
authors.forename: J
authors.initials: J
authors.lastname: Soeda
authors.forename: A
authors.initials: A
authors.lastname: Kobayashi
authors.forename: T
authors.initials: T
authors.lastname: Noike
authors.forename: S
authors.initials: S
authors.lastname: Miyagawa
authors.forename: S
authors.initials: S
authors.lastname: Kawasaki
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000601:surgery* / Q000628:therapy; D016461:Chemoembolization, Therapeutic; D003131:Combined Modality Therapy; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000601:surgery* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012421:Rupture; D016019:Survival Analysis