title: Spontaneous rupture of hepatocellular carcinoma: conservative management and selective intervention.
abstract: OBJECTIVE
  A conservative approach using selective intervention is better than an aggressive approach using nonselective intervention for ruptured hepatocellular carcinoma.
  
  
  METHODS
  Nonrandomized controlled trial.
  
  
  METHODS
  A university hospital.
  
  
  METHODS
  From 1984 to 1990, an aggressive approach was adopted in which 29 and 8 of a total of 40 patients underwent surgical intervention or attempted transarterial embolization (TAE), respectively. From 1991 to 1997, a more conservative approach was used. The initial treatment for 72 patients was conservative with close monitoring. Additional hemostatic procedures consisting of TAE (n = 13) or surgical intervention (n = 9) were given, depending on the clinical progress, disease status, and liver function of the patients.
  
  
  METHODS
  In-hospital mortality, survival.
  
  
  RESULTS
  In-hospital mortality rate was 62% (25 of 40 patients) in the first period and 51% (37 of 72 patients) in the second period. The respective median survival times were 7 and 12 days. If 36 patients with end-stage malignant neoplasms were excluded, the in-hospital mortality rate became 60% (18 of 30 patients) in the first period and 35% (16 of 46 patients) in the second period (P = .03, chi2 test). The respective median survival times became 8 and 72 days (P = .02, log rank test). In the second period, 7 (54%) of 13 patients who underwent TAE and 1 (11%) of 9 patients who underwent surgical intervention died within the same hospital admission (P = .07, Fisher exact test).
  
  
  CONCLUSIONS
  Selective intervention was cost-effective and gave better results than an aggressive approach. When intervention was indicated for hemostasis, surgery seemed better than TAE although the difference was not statistically significant.
authors.affiliation: Department of Surgery, the Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories.
authors.forename: K L
authors.initials: KL
authors.lastname: Leung
authors.forename: W Y
authors.initials: WY
authors.lastname: Lau
authors.forename: P B
authors.initials: PB
authors.lastname: Lai
authors.forename: R Y
authors.initials: RY
authors.lastname: Yiu
authors.forename: W C
authors.initials: WC
authors.lastname: Meng
authors.forename: C K
authors.initials: CK
authors.lastname: Leow
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000150:complications*; D005260:Female; D006801:Humans; D008107:Liver Diseases / Q000209:etiology* / Q000401:mortality / Q000628:therapy*; D008113:Liver Neoplasms / Q000150:complications*; D008297:Male; D008875:Middle Aged; D012422:Rupture, Spontaneous