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Bleeding Recurrence and Mortality Following Interventional Management of Spontaneous HCC Rupture: Results of a Multicenter European Study

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Abstract

Background

The incidence of spontaneous rupture of hepatocellular carcinoma (HCC) is low in Europe, at less than 3%. HCC rupture remains a life-threatening complication, with mortality reported between 16 and 30%. The risk of bleeding recurrence has never been clearly evaluated in such clinical situation. The objectives of this study were to evaluate the current risk of mortality related to HCC rupture and to focus on the risk of bleeding recurrence following interventional management.

Methods

All patients admitted to 14 French–Italian surgical centers for spontaneous rupture of HCC between May 2000 and May 2012 were retrospectively included. Clinical data, imaging features, relevant laboratory data, treatment strategies, and prognoses were analyzed.

Results

Overall, 58 of the 138 included patients (42%) had cirrhosis. Thirty-five patients (25%) presented with hemorrhagic shock, and 19% with organ(s) dysfunction. Bleeding control was obtained by interventional hemostasis, emergency liver resection, and conservative medical management in 86 (62%), 24 (18%), and 21 (15%) patients, respectively. Best supportive care was chosen for 7 (5%) patients. The mortality rate following rupture was 24%. The bleeding recurrence rate was 22% with related mortality of 52%. In multivariate analysis, a bilirubin level >17 micromol/L (HR 3.768; p = 0.006), bleeding recurrence (HR 5.400; p < 0.0001), and ICU admission after initial management (HR 8.199; p < 0.0001) were associated with in-hospital mortality.

Conclusion

This European, multicenter, large-cohort study confirmed that the prognosis of ruptured HCC is poor with an overall mortality rate of 24%, despite important advances in endovascular techniques. Overall, the rate of bleeding recurrence was more than 20%, with a related high risk of mortality.

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Acknowledgements

We are grateful to Nikki Sabourin-Gibbs, Rouen University Hospital, for writing assistance and review of the manuscript in English.

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Authors and Affiliations

  1. Department of Digestive Surgery, HĂ´pital Charles Nicolle, Rouen University Hospital, Rouen, France

    Lilian Schwarz & Jean Jacques Tuech

  2. Department of Biostatistics, HĂ´pital Charles Nicolle, Rouen University Hospital, Rouen, France

    Michael Bubenheim

  3. Department of General Surgery and Liver Transplantation, APHM, HĂ´pital de la Conception, Marseille University Hospital, Marseille, France

    Johanna Zemour & Yves Patrice Le Treut

  4. Department of Digestive Surgery, HĂ´pital Saint Eloi, Montpellier University Hospital, Montpellier, France

    Astrid Herrero

  5. Department of Digestive Surgery and Liver Transplantation, HĂ´pital Rangueil, Toulouse University Hospital, Toulouse, France

    Fabrice Muscari

  6. Department of HPB Surgery, Nancy University Hospital, Nancy, France

    Ahmet Ayav

  7. Department of Emergency and Digestive Surgery, Grenoble University Hospital, Grenoble, France

    Romain Riboud

  8. Department of Digestive Surgery and Liver Transplantation, HĂ´pital de la Croix Rousse, Lyon University Hospital, Lyon, France

    Christian Ducerf

  9. Department of Digestive Surgery, HĂ´pital Nord, Amiens University Hospital, Amiens, France

    J-Marc Regimbeau

  10. Department of Minimally Invasive Surgery, Hôpital Antoine Béclère, Clamart, France

    Hadrien Tranchart

  11. Department of digestive Surgery, Angers University Hospital, Angers, France

    Emilie Lermite

  12. Department of Digestive Surgery and Liver Transplantation, HĂ´pital Huriez, Nord-de-France University Hospital, Lille, France

    Gheorghe Petrovai

  13. Department of Digestive Surgery and Liver Transplantation, Hôpital La Pitié Salpétrière, APHP, Paris, France

    Amal Suhol

  14. Department of Digestive Surgery, Dijon University Hospital, Dijon, France

    Alexandre Doussot

  15. Department of HPB and Digestive Surgery, Ospedale Mauriziano Umberto, Turin, Italy

    Lorenzo Capussotti

  16. Normandie University, UNIROUEN, Inserm U1245, Team 3, IRON group, Rouen University Hospital, Normandy Centre for Genomic and Personalized Medicine, 76000, Rouen, France

    Lilian Schwarz & Jean Jacques Tuech

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  1. Lilian Schwarz
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  17. Yves Patrice Le Treut
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Correspondence to Lilian Schwarz.

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Conflict of interest

LS, MB, JZ, AH, FM, AA, RR, CD, JMR, HT, EL, GP, AS, AD, LC, YPLT, and JJT have no conflict of interest.

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Schwarz, L., Bubenheim, M., Zemour, J. et al. Bleeding Recurrence and Mortality Following Interventional Management of Spontaneous HCC Rupture: Results of a Multicenter European Study. World J Surg 42, 225–232 (2018). https://doi.org/10.1007/s00268-017-4163-8

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  • DOI: https://doi.org/10.1007/s00268-017-4163-8

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