Comparison of the prognostic influence of emergency hepatectomy and staged hepatectomy in patients with ruptured hepatocellular carcinoma.
BACKGROUND
Spontaneous hepatocellular carcinoma (HCC) rupture is a fatal complication of primary liver cancer and is associated with poor surgical outcomes. Whether emergency hepatectomy or staged hepatectomy should be performed in the situations of a spontaneous rupture for resectable HCC need to be investigated.


METHODS
Between January 2005 and December 2014, 131 patients with HCC ruptures received emergency or staged hepatectomy in our hospital and were included in this study. We retrospectively compared the postoperative morbidity and mortality, overall survival (OS), and disease-free survival (DFS) of patients who received emergency or staged hepatectomies. Independent prognostic predictors were identified using the Cox multivariate regression analysis.


RESULTS
Emergency hepatectomy could be performed for successful surgical hemostasis and radical tumor resection. However, the in-hospital mortality rate was 11.0%, which correlated with INR, liver function, shock, blood transfusion, and aggressive treatment by emergency hepatectomy (P<0.05). Conversely, the 1-, 3-, and 5-year overall survival rates of ruptured HCC patients with staged hepatectomy were 82.8%, 55.2%, and 41.4%; and the disease-free survival rates were 70.7%, 44.8%, and 27.6%, respectively. The overall survival and disease-free survival of staged hepatectomy group were longer than that of emergency hepatectomy group (P=0.034, P=0.019). Multivariable analyses of HCC ruptures patients indicated that tumor sizes more than 10cm and multiple-nodule tumors were independent predictors of poor long-term survival.


CONCLUSIONS
Though they carry some risk, emergency hepatectomy is still an important means of treatment for spontaneous HCC ruptures. For resectable HCC ruptures, emergency hepatectomy or staged hepatectomy are life-saving procedures, and efficient therapeutic methods. After the initial hemostasis, staged liver resection can often help patients achieve better long-term survival than emergency hepatectomy.
Department of Geriatric Surgery, Xiangya Hospital, Central South University, Changsha 410008, Hunan, China. Electronic address: douglasou@126.com.
Dipeng
D
Ou
Department of Geriatric Surgery, Xiangya Hospital, Central South University, Changsha 410008, Hunan, China. Electronic address: yh727888@126.com.
Hao
H
Yang
Department of Geriatric Surgery, Xiangya Hospital, Central South University, Changsha 410008, Hunan, China. Electronic address: zengzhijun53@126.com.
Zhijun
Z
Zeng
Department of Geriatric Surgery, Xiangya Hospital, Central South University, Changsha 410008, Hunan, China.
Yijiang
Y
Luo
Department of Surgery, Xiangya Hospital, Central South University, Changsha 410008, Hunan, China. Electronic address: lianyueyang@hotmail.com.
Lianyue
L
Yang
D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000601:surgery*; D002681:China; D004630:Emergencies; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D017052:Hospital Mortality; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012422:Rupture, Spontaneous / Q000601:surgery*; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome
Emergency hepatectomy; Hepatocellular carcinoma; Prognosis; Spontaneous rupture; Staged hepatectomy