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Surgical Outcomes of Spontaneously Ruptured Hepatocellular Carcinoma

  • Original Article
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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Surgical and oncological outcomes in ruptured hepatocellular carcinoma (HCC) are not well known. The objective of this study was to review and compare survival outcomes and recurrence rates between ruptured and unruptured HCC.

Methods

Data of patients with ruptured HCC who underwent curative surgical resection between January 2000 and December 2016 were retrospectively reviewed. To compare survival outcomes between ruptured and unruptured HCC, 1:2 individual matching was conducted.

Results

The 1-, 3-, and 5-year overall survival (OS) rates were 88.8%, 67.0%, and 51.9%, respectively. The 1-, 3-, and 5-year disease-free survival (DFS) rates were 51.7%, 32.8%, and 25.0%, respectively. OS and DFS rates were significantly lower in the ruptured HCC group than the matched unruptured HCC group. HCC recurred in 63 patients (70.8%), 33 (52.4%) of whom presented with both intrahepatic and extrahepatic recurrences. Mean recurrence interval was 12.6 ± 13.8 months. The 1-, 3-, and 5-year survival rates after recurrence were 61.6%, 40.2%, and 33.6%, respectively. Mean survival time after recurrence was 26.4 ± 29.5 months. Incidence of peritoneal seeding (PS) was 18.0%, and eight of them demonstrated solitary lesion. Mean recurrence interval was 5.9 ± 8.2 months. The 1-, 3-, and 5-year OS rates after recurrence were significantly lower in patients with PS (49.7%, 18.7%, and 9.3%, respectively) than in patients without PS.

Conclusions

Hepatectomy in ruptured HCC did show worse survival outcome compared with unruptured HCC and bear a high risk of PS. However, surgical resection combined with transcatheter arterial chemoembolization could help in achieving acceptable oncological outcomes.

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Abbreviations

HCC:

Hepatocellular carcinoma

AJCC/UICC:

American Joint Committee on Cancer/Union for International Cancer Control

LCSGJ:

Liver Cancer Study Group of Japan

HBV:

Hepatitis B virus

PS:

Peritoneal seeding

AFP:

Alpha fetoprotein

PET:

Positron emission tomography

CT:

Computed tomography

MRI:

Magnetic resonance imaging

TACE:

Transcatheter arterial chemoembolization

mRECIST:

Modified Response Evaluation Criteria in Solid Tumors

OS:

Overall survival

DFS:

Disease-free survival

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Funding

The present work was supported by a fund from the National Research Foundation of Korea (NRF-2015K1A4A3046807).

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Authors and Affiliations

  1. Division of Liver Transplantation and Hepatobiliary Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

    Jae Hyun Kwon, Gi-Won Song, Shin Hwang, Ki-Hun Kim, Chul-Soo Ahn, Deok-Bog Moon, Tae-Yong Ha, Dong-Hwan Jung, Gil-Chun Park, Young-In Yoon & Sung-Gyu Lee

  2. Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea

    Ju Hyun Shim

  3. Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea

    Kyong Won Kim

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  1. Jae Hyun Kwon
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Contributions

Our manuscript has 13 authors, all of whom contributed significantly to this study. Jae Hyun Kwon, Gi-Won Song, and Sung-Gyu Lee made substantial contributions to study conception and design. Shin Hwang, Ki-Hun Kim, Chul-Soo Ahn, Deok-Bog Moon, Tae-Yong Ha, Dong-Hwan Jung, Gil-Chun Park, Young-In Yoon, Ju Hyun Shim, and Kyong Won Kim participated in data acquisition and analysis. Jae Hyun Kwon and Gi-Won Song participated in the drafting of the article and critical revisions to ensure appropriate communication of important intellectual content.

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Correspondence to Gi-Won Song.

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Kwon, J.H., Song, GW., Hwang, S. et al. Surgical Outcomes of Spontaneously Ruptured Hepatocellular Carcinoma. J Gastrointest Surg 25, 941–953 (2021). https://doi.org/10.1007/s11605-020-04555-0

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