title: Surgical Outcomes for the Ruptured Hepatocellular Carcinoma: Multicenter Analysis with a Case-Controlled Study.
abstract: While spontaneously ruptured hepatocellular carcinoma (HCC) has a poor prognosis, the true impact of a rupture on survival after hepatic resection is unclear.
  
  
  
  Fifty-eight patients with ruptured HCC and 1922 with non-ruptured HCC underwent hepatic resection between 2000 and 2013. To correct the difference in the clinicopathological factors between the two groups, propensity score matching (PSM) was used at a 1:1 ratio, resulting in a comparison of 42 patients/group. We investigated outcomes in all patients with ruptured HCC and compared outcomes between the two matched groups.
  
  
  
  Of the 58 patients with ruptured HCC, 7 patients (13 %) died postoperatively. Overall survival (OS) rate at 5 years after hepatic resection was 37 %. Emergency hepatic resection was an independent risk factor for in-hospital death and Child-Pugh class B for unfavorable OS in multivariate analysis. Clinicopathological variables were well-balanced between the two groups after PSM. No significant differences were noted in incidence of in-hospital death (ruptured HCC 12 % vs non-ruptured HCC 2 %, p = 0.202) or OS rate (5/10-year; 42 %/38 % vs 67 %/30 %, p = 0.115).
  
  
  
  Emergency hepatic resection should be avoided for ruptured HCC in Child-Pugh class B patients. Rupture itself was not a risk for unfavorable surgical outcomes.
authors.affiliation: Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abenoku, Osaka, 545-8585, Japan. m8827074@msic.med.osaka-cu.ac.jp.
authors.forename: Shogo
authors.initials: S
authors.lastname: Tanaka
authors.affiliation: Department of Surgery, Hirakata Hospital, Kansai Medical University, Hirakata, Osaka, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Kaibori
authors.affiliation: Second Department of Surgery, Wakayama Medical University, Wakayama, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Ueno
authors.affiliation: Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Wada
authors.affiliation: Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Osaka, Japan.
authors.forename: Fumitoshi
authors.initials: F
authors.lastname: Hirokawa
authors.affiliation: Department of Surgery, Faculty of Medicine, Kinki University, Osaka-Sayama, Osaka, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Nakai
authors.affiliation: Department of Surgery, Hirakata Hospital, Kansai Medical University, Hirakata, Osaka, Japan.
authors.forename: Hiroya
authors.initials: H
authors.lastname: Iida
authors.affiliation: Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan.
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Eguchi
authors.affiliation: Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Osaka, Japan.
authors.forename: Michihiro
authors.initials: M
authors.lastname: Hayashi
authors.affiliation: Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abenoku, Osaka, 545-8585, Japan.
authors.forename: Shoji
authors.initials: S
authors.lastname: Kubo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D016022:Case-Control Studies; D004630:Emergencies; D005260:Female; D006304:Health Status; D006498:Hepatectomy; D017052:Hospital Mortality; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D057216:Propensity Score; D012189:Retrospective Studies; D012307:Risk Factors; D012422:Rupture, Spontaneous / Q000601:surgery; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Child-Pugh class B; Extrahepatic recurrence; Milan criteria