title: Surgery for pregnancy-associated primary hepatocellular carcinoma: Report of four cases.
abstract: BACKGROUND
  Hepatocellular carcinoma (HCC) occurring in pregnancy is quite rare. The prognosis is usually poor because of a delay in diagnosis. Reported cases of HCC in pregnancy are largely isolated with no large experience. Thus the effect of pregnancy on the prognosis of patients with HCC and the risk factors of developing HCC in pregnancy are not well documented. Our aim was to review our experience with management of four young pregnant women with HCC.
  
  
  METHODS
  Laboratory tests were performed before surgery. We analyzed the effects of age, hepatitis B surface antigens status, cirrhosis at presentation, gestational age of fetus, and maternal outcome.
  
  
  CONCLUSIONS
  Increase in alpha-fetoprotein (AFP) level was somewhat useful for diagnosis. Three patients died in 5 months, 6 months, and 24 months from HCC recurrence, and another patient is alive without disease 12 months postoperatively.
  
  
  CONCLUSIONS
  Surgery for HCC during pregnancy should be similar to that for non-pregnant women. Complete excision of tumor without termination of pregnancy provides the greatest chance of survival for women with HCC during pregnancy but depends on gestational age of the fetus. Adjuvant treatments are required to improve the long-term results of this type of surgery. The 28-week gestational week is a critical point of fetal maturation which is very important in deciding whether pregnancy should be terminated or not. The pregnancy was terminated in two of our patients when spontaneous rupture of HCC was diagnosed to save the mother's life.
authors.affiliation: Department of the 2nd Special Treatment, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, 225, Changhai Road, Shanghai 200438, China. Electronic address: ajli62@gmail.com.
authors.forename: Ai-Jun
authors.initials: AJ
authors.lastname: Li
authors.affiliation: Department of the 3rd Liver Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, 225, Changhai Road, Shanghai 200438, China. Electronic address: Ehphwp@126.com.
authors.forename: Wei-Ping
authors.initials: WP
authors.lastname: Zhou
authors.affiliation: Department of the 6th Liver Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, 225, Changhai Road, Shanghai 200438, China. Electronic address: lujh0810@163.com.
authors.forename: Jun-Hua
authors.initials: JH
authors.lastname: Lu
authors.affiliation: Department of the 2nd Special Treatment, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, 225, Changhai Road, Shanghai 200438, China. Electronic address: longjiu2006@126.com.
authors.forename: Long-Jiu
authors.initials: LJ
authors.lastname: Cui
authors.affiliation: Department of the 2nd Special Treatment, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, 225, Changhai Road, Shanghai 200438, China. Electronic address: brian1979627@hotmail.com.
authors.forename: Xiao-Yu
authors.initials: XY
authors.lastname: Yang
authors.affiliation: Department of the 2nd Special Treatment, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, 225, Changhai Road, Shanghai 200438, China. Electronic address: yinlei409@hotmail.com.
authors.forename: Lei
authors.initials: L
authors.lastname: Yin
authors.affiliation: Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, 225, Changhai Road, Shanghai 200438, China. Electronic address: qiufujian@sina.com.
authors.forename: Meng-Chao
authors.initials: MC
authors.lastname: Wu
keywords: Gestational age; Hepatocellular carcinoma; Liver neoplasm; Pregnancy; Spontaneous rupture