Short article: Management of ruptured hepatocellular carcinoma in a European tertiary care center.
OBJECTIVE
Spontaneous rupture is a rare complication of hepatocellular carcinoma (HCC). Treatment options consist of transcatheter arterial embolization (TAE), hepatic resection, and conservative therapy. The best approach is under debate.


METHODS
This study presents a review of clinical data of patients with a ruptured HCC admitted to a European tertiary care center.


RESULTS
Eleven patients were included; six (55%) had underlying cirrhosis. The majority of patients (73%) had no previous history of HCC. Spontaneous HCC rupture was diagnosed using abdominal computed tomography with or without a diagnostic paracentesis. Computed tomography showed one or two tumors in eight (73%) patients; the other patients had multiple tumors or diffuse infiltrative HCC. Seven (64%) patients were initially treated by TAE and one (9%) patient underwent hepatic resection. The remaining three (27%) patients, all of whom had liver cirrhosis, received conservative therapy. Two patients initially treated by TAE underwent a delayed resection and ultimately received systemic therapy. Overall, at the end of the follow-up period, three patients were still alive at 84, 991, and 1026 days after the initial presentation. Eight (73%) patients had died after a median of 88 days (range 7-417). One year after presentation, none of the conservatively treated patients was alive compared with three out of seven (43%) patients treated with TAE with or without delayed resection.


CONCLUSIONS
Patients with a spontaneously ruptured HCC have a poor prognosis. In selected patients, however, prolonged survival is possible using TAE as initial therapy with or without a delayed resection and systemic therapy.
Departments of aGastroenterology and Hepatology bRadiology cSurgery, Erasmus MC University Medical Center Rotterdam dDepartment of Surgery, Division of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam eDepartment of Gastroenterology and Hepatology, Máxima Medical Center, Veldhoven, The Netherlands.
Vincent
V
Rijckborst
Martijn J
MJ
Ter Borg
Eric T
ET
Tjwa
Dave
D
Sprengers
Kees
K
Verhoef
Adriaan
A
Moelker
Jan N
JN
Ijzermans
Robert A
RA
de Man
D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D019152:Paracentesis; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D012422:Rupture, Spontaneous; D062606:Tertiary Care Centers; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000970:Antineoplastic Agents