Management of spontaneously ruptured hepatocellular carcinomas in the radiofrequency ablation era.
OBJECTIVE
Spontaneous rupture of hepatocellular carcinoma (HCC) carries a high mortality. The use of radiofrequency ablation (RFA) in recent years has enriched the armamentarium for hemostasis of spontaneously ruptured HCCs but its results have not been documented. This study investigated the prognosis and outcome of spontaneous rupture of HCC as well as the results of using RFA for hemostasis.


METHODS
From January 1991 to December 2010, 5283 patients were diagnosed with HCC at our hospital, and 189 of them had spontaneous rupture of HCCs. They were grouped under two periods: period 1, 1991-2000, n = 70; period 2, 2001-2010, n = 119. RFA was available in period 2 only.


RESULTS
Hepatitis B virus infection was predominant in both periods. Surgical hemostasis was mainly achieved by hepatic artery ligation in period 1 and by RFA in period 2. The 30-day hospital mortality after surgical treatment was 55.6% (n = 18) in period 1 and 19.2% (n = 26) in period 2 (p = 0.012). Multivariate analysis identified 4 independent factors for better overall survival, namely, hemostasis by transarterial embolization [corrected] (hazard ratio 0.516, 95% confidence interval 0.354-0.751), hemostasis by RFA (hazard ratio 0.431, 95% confidence interval 0.236-0.790), having surgery as a subsequent treatment (hazard ratio 0.305, 95% confidence interval 0.186-0.498), and a serum total bilirubin level <19 umol/L (hazard ratio 1.596, 95% confidence interval 1.137-2.241).


CONCLUSIONS
The use of RFA for hemostasis during laparotomy greatly reduced the hospital mortality rate when compared with conventional hepatic artery ligation.
Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China.
Tan To
TT
Cheung
Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China.
Ronnie T P
RT
Poon
Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China.
Kenneth S H
KS
Chok
Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China.
Albert C Y
AC
Chan
Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China.
Simon H Y
SH
Tsang
Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China.
Wing Chiu
WC
Dai
Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China.
Thomas C C
TC
Yau
Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China.
See Ching
SC
Chan
Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China.
Sheung Tat
ST
Fan
Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China.
Chung Mau
CM
Lo
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation; D003710:Demography; D005260:Female; D006487:Hemostasis; D017052:Hospital Mortality; D006801:Humans; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D012307:Risk Factors; D012422:Rupture, Spontaneous / Q000503:physiopathology / Q000601:surgery; D016019:Survival Analysis; D055815:Young Adult