title: Management of ruptured hepatocellular carcinoma: implications for therapy.
abstract: OBJECTIVE
  To assess the treatment and tumor-related variables associated with outcome after treatment of spontaneously ruptured hepatocellular carcinoma (HCC).
  
  
  METHODS
  Patients with ruptured HCC were identified. The complications, mortality and survival were assessed. The relationship between tumor size and the severity of hemoperitoneum and between tumor size and grade were examined.
  
  
  RESULTS
  From January 1993 to January 2008, 556 patients with HCC with or without cirrhosis were evaluated; of which, 16 (2.87%) presented with spontaneous rupture. All but 1 patient had cirrhosis. Twelve patients underwent surgical resection while 4 underwent trans-cutaneous arterial catheter embolization (TAE) (trans-cutaneous arterial embolization). Early mortality (< 30 d) was 25% (4 of 16) and was inversely related to Child-Pugh score; 3 of the 4 early deaths occurred in patients treated with TAE with 1 of 12 occurring in the resected group. There was no correlation between tumor size and grade or between size and severity of hemoperitoneum.
  
  
  CONCLUSIONS
  Tumor size did not correlate with severity of the hemoperitoneum. There was an inverse relationship between G1-G3 (grade of cellular differentiation) HCC and dimensions.
authors.affiliation: IV Unit of Surgery, Regional Reference Center of Hepato-Biliary-Pancreatic Surgery, 31100 Treviso, Italy.
authors.forename: Nicolò
authors.initials: N
authors.lastname: Bassi
authors.forename: Ezio
authors.initials: E
authors.lastname: Caratozzolo
authors.forename: Luca
authors.initials: L
authors.lastname: Bonariol
authors.forename: Cesare
authors.initials: C
authors.lastname: Ruffolo
authors.forename: Alessio
authors.initials: A
authors.lastname: Bridda
authors.forename: Luigi
authors.initials: L
authors.lastname: Padoan
authors.forename: Michele
authors.initials: M
authors.lastname: Antoniutti
authors.forename: Marco
authors.initials: M
authors.lastname: Massani
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000150:complications* / Q000401:mortality / Q000601:surgery; D004621:Embolization, Therapeutic; D005260:Female; D006465:Hemoperitoneum / Q000209:etiology* / Q000628:therapy; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008113:Liver Neoplasms / Q000150:complications* / Q000401:mortality / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012422:Rupture, Spontaneous