Survival after transarterial embolization for spontaneous ruptured hepatocellular carcinoma.
OBJECTIVE
To examine the survival of patients with spontaneous ruptured hepatocellular carcinoma treated with transarterial embolization (TAE).


METHODS
Patients diagnosed with spontaneous ruptured hepatocellular carcinoma treated with TAE were retrospectively studied. Hospital records were reviewed and data were collected and analyzed from the years 2000-2006. A total of 62 patients who had been diagnosed with spontaneous ruptured hepatocellular carcinoma were managed in our hospital during this period.


RESULTS
All 62 patients (who had been diagnosed with ruptured hepatocellular carcinoma and were managed in our hospital) patients were treated with TAE, with a success rate of 91% (57/62). Early mortality (within 30 days after rupture) was 38%. Factors that were associated with early mortality were old age, low hemoglobin at presentation, elevated bilirubin at presentation, prolonged prothrombin time at presentation (INR > 1.3), low albumin level at presentation, and unsuccessful embolization. A low albumin level was the only independent risk factor for early mortality. The overall median survival time was 39 days. Surgical resections were possible in seven patients. Their cumulative survival was significantly longer (P = 0.002) than that of patients managed with non-operative treatment after embolization.


CONCLUSIONS
Transarterial embolization (TAE) can achieve good hemostasis, though low albumin level, which reflects poor liver reserve, may predict early mortality. Portal vein thrombosis should not be regarded as an absolute contraindication for TAE. Staged surgical resection after embolization is safe and produces a good survival outcome.
Li
Wing-Hong
WH
Department of Surgery, Queen Elizabeth Hospital, 31A, Hilary Court, 63G Bonham Road, Hong Kong, Hong Kong. Patvic@netvigator.com
Cheuk
Edmond Cheung-Yan
EC
Kowk
Philip Chong-Hei
PC
Cheung
Moon-Tong
MT
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000601:surgery*; D004621:Embolization, Therapeutic; D005260:Female; D006488:Hemostasis, Surgical; D017052:Hospital Mortality; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011169:Portal Vein; D012189:Retrospective Studies; D012422:Rupture, Spontaneous; D020246:Venous Thrombosis