title: Multidisciplinary management of ruptured hepatocellular carcinoma.
abstract: Spontaneous rupture of hepatocellular carcinoma (HCC) is a dramatic presentation of the disease. Most published studies are from Asian centers, and North American experience is limited. This study was undertaken to review the experience of ruptured HCC at a North American multidisciplinary unit. Thirty patients presenting with ruptured HCC at a tertiary care center from 1985 to 2004 were studied retrospectively and analyzed according to the demographics, clinical presentation, tumor characteristics, treatment, and outcome in four treatment groups: emergency resection, delayed resection (resection after angiographic embolization), transcatheter arterial embolization (TAE), and conservative management. Ten, 10, 7, and 3 patients underwent emergency resection, delayed resection, TAE, and conservative treatment, respectively. The mean age of all patients was 57 years, and the mean Child-Turcotte-Pugh score was 7 +/- 2. Cirrhosis was present in 57% of the patients. Seventy percent of tumors were greater than 5 cm in diameter, and 68% of patients had multiple tumors. There was a trend toward higher 30-day mortality in the emergency resection group than in the delayed resection group. One-year survival was significantly better in the delayed resection group. In selected patients, the multidisciplinary approach of angiographic embolization and delayed resection affords better short-term survival than emergency resection.
authors.affiliation: Division of General Surgery, Department of Surgery, Vancouver Hospital and Health Sciences Center, 855 West 10th Avenue, Vancouver, British Colombia, Canada V5Z 1L7. andrzej.buczkowski@vch.ca
authors.forename: Andrzej K
authors.initials: AK
authors.lastname: Buczkowski
authors.forename: Peter T W
authors.initials: PT
authors.lastname: Kim
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Ho
authors.forename: David F
authors.initials: DF
authors.lastname: Schaeffer
authors.forename: Sung I
authors.initials: SI
authors.lastname: Lee
authors.forename: David A
authors.initials: DA
authors.lastname: Owen
authors.forename: Alan H
authors.initials: AH
authors.lastname: Weiss
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Chung
authors.forename: Charles H
authors.initials: CH
authors.lastname: Scudamore
mesh_terms: D000792:Angiography; D006528:Carcinoma, Hepatocellular / Q000601:surgery / Q000628:therapy*; D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012422:Rupture, Spontaneous; D015996:Survival Rate; D016896:Treatment Outcome