Ruptured Hepatocellular Carcinoma-Experience in a Tertiary Centre in Western Australia
International Journal of Gastroenterology
Volume 2, Issue 1, June 2018, Pages: 18-23
Received: Sep. 15, 2018; Accepted: Oct. 8, 2018; Published: Nov. 7, 2018
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Sarah Ng, Department of Gastroenterology & Hepatology, Royal Perth Hospital, Perth, Australia
Justin Chin, Department of Gastroenterology & Hepatology, Royal Perth Hospital, Perth, Australia
Sudhakar Rao, Department of General Surgery, Royal Perth Hospital, Perth, Australia
Nick Kontorinis, Department of Gastroenterology & Hepatology, Royal Perth Hospital, Perth, Australia
James Anderson, Department of Radiology, Royal Perth Hospital, Perth, Australia
Suresh Navadgi, Department of General Surgery, Royal Perth Hospital, Perth, Australia
Jee Kong, Department of Gastroenterology & Hepatology, Royal Perth Hospital, Perth, Australia
Adam Doyle, Department of Gastroenterology & Hepatology, Royal Perth Hospital, Perth, Australia
Wendy Cheng, Department of Gastroenterology & Hepatology, Royal Perth Hospital, Perth, Australia; School of Medicine and Health Services, Edith Cowan University, Perth, Australia; Department of Medicine, University of Western Australia, Perth, Australia
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Hepatocellular carcinoma (HCC) is a leading cause of cancer-related deaths worldwide. Spontaneous tumour rupture (STR) is uncommon, with incidence rates around 10-15% in Asia, but below 3% in Western countries. Nonetheless, serious complications lead to high mortality rates. To our knowledge, experience of HCC rupture has not been published in Australia. We identified 9 retrospective cases of ruptured HCC from 2008 to 2017 through patient case notes, electronic laboratory system, and imaging reports. Our case series presents 8 male and 1 female patient with a mean age of 56 years, and a median 11 month follow-up period. Sixty-six percent of patients were non-cirrhotic, and 33% cirrhotic, with a median post- tumour rupture survival rate of 10 months and 12 months, respectively. Seventy-eight percent of patients presented with abdominal pain and a mean tumour size of 8cm at time of rupture. Initial management involved: trans-arterial chemoembolisation (TACE)/ trans-arterial embolisation (TAE) in 4 patients, emergency hepatic resection in 3 patients, sorafenib in 1 patient and conservative/ supportive treatment in 1 patient. Reasons for our low HCC rupture incidence at 0.3% could be due to: none of our patients experiencing rebleeding (one of the common causes of mortality); strict surveillance programmes in Australia identifying early tumours; and majority of our patients being younger and non-cirrhotic with a better underlying liver reserve at time of rupture, and therefore improved outcomes.
Ruptured Hepatocellular Carcinoma, Trans-Arterial Chemoembolisation, Trans-Arterial Embolisation
To cite this article
Sarah Ng, Justin Chin, Sudhakar Rao, Nick Kontorinis, James Anderson, Suresh Navadgi, Jee Kong, Adam Doyle, Wendy Cheng, Ruptured Hepatocellular Carcinoma-Experience in a Tertiary Centre in Western Australia, International Journal of Gastroenterology. Vol. 2, No. 1, 2018, pp. 18-23. doi: 10.11648/j.ijg.20180201.14
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Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015 Mar 1; 136 (5):E359-86. doi: 10.1002/ijc.29210. PubMed PMID: 25220842.
Fattovich G, Stroffolini T, Zagni I, et al. Hepatocellular carcinoma in cirrhosis: incidence and risk factors. Gastroenterology. 2004 Nov; 127 (5 Suppl 1):S35-50. PubMed PMID: 15508101.
Yoshida H, Mamada Y, Taniai N, et al. Spontaneous ruptured hepatocellular carcinoma. Hepatol Res. 2016 Jan; 46 (1):13-21. doi: 10.1111/hepr.12498. PubMed PMID: 25631290.
Lai EC, Lau WY. Spontaneous rupture of hepatocellular carcinoma: a systematic review. Arch Surg. 2006 Feb; 141 (2):191-8. doi: 10.1001/archsurg.141.2.191. PubMed PMID: 16490898.
Liu CL, Fan ST, Lo CM, et al. Management of spontaneous rupture of hepatocellular carcinoma: single-center experience. J Clin Oncol. 2001 Sep 1; 19 (17):3725-32. doi: 10.1200/JCO.2001.19.17.3725. PubMed PMID: 11533094.
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. 2018 Jan; 42 (1):225-232. doi: 10.1007/s00268-017-4163-8. PubMed PMID: 28799103.
Battula N, Madanur M, Priest O, et al. Spontaneous rupture of hepatocellular carcinoma: a Western experience. Am J Surg. 2009 Feb; 197 (2):164-7. doi: 10.1016/j.amjsurg.2007.10.016. PubMed PMID: 18926518.
Hari DM, Leung AM, Lee JH, et al. AJCC Cancer Staging Manual 7th edition criteria for colon cancer: do the complex modifications improve prognostic assessment? J Am Coll Surg. 2013 Aug; 217 (2):181-90. doi: 10.1016/j.jamcollsurg.2013.04.018. PubMed PMID: 23768788; PubMed Central PMCID: PMCPMC4657944.
Heimbach JK, Kulik LM, Finn RS, et al. AASLD guidelines for the treatment of hepatocellular carcinoma. Hepatology. 2018 Jan; 67 (1):358-380. doi: 10.1002/hep.29086. PubMed PMID: 28130846.
Zhu Q, Li J, Yan JJ, et al. Predictors and clinical outcomes for spontaneous rupture of hepatocellular carcinoma. World J Gastroenterol. 2012 Dec 28; 18 (48):7302-7. doi: 10.3748/wjg.v18.i48.7302. PubMed PMID: 23326137; PubMed Central PMCID: PMCPMC3544034.
Zhu LX, Geng XP, Fan ST. Spontaneous rupture of hepatocellular carcinoma and vascular injury. Arch Surg. 2001 Jun; 136 (6):682-7. PubMed PMID: 11387009.
Zhu LX, Wang GS, Fan ST. Spontaneous rupture of hepatocellular carcinoma. Br J Surg. 1996 May; 83 (5):602-7. PubMed PMID: 8689200.
Ong GB, Taw JL. Spontaneous rupture of hepatocellular carcinoma. Br Med J. 1972 Oct 21; 4 (5833):146-9. PubMed PMID: 4342761; PubMed Central PMCID: PMCPMC1786419.
Chearanai O, Plengvanit U, Asavanich C, et al. Spontaneous rupture of primary hepatoma: report of 63 cases with particular reference to the pathogenesis and rationale treatment by hepatic artery ligation. Cancer. 1983 Apr 15; 51 (8):1532-6. PubMed PMID: 6297703.
Vergara V, Muratore A, Bouzari H, et al. Spontaneous rupture of hepatocelluar carcinoma: surgical resection and long-term survival. Eur J Surg Oncol. 2000 Dec; 26 (8):770-2. doi: 10.1053/ejso.2000.1001. PubMed PMID: 11087643.
Choi BG, Park SH, Byun JY, et al. The findings of ruptured hepatocellular carcinoma on helical CT. Br J Radiol. 2001 Feb; 74 (878):142-6. doi: 10.1259/bjr.74.878.740142. PubMed PMID: 11718385.
Rijckborst V, Ter Borg MJ, Tjwa ET, et al. Short article: Management of ruptured hepatocellular carcinoma in a European tertiary care center. Eur J Gastroenterol Hepatol. 2016 Aug; 28 (8):963-6. doi: 10.1097/MEG.0000000000000652. PubMed PMID: 27116657.
Tarantino L, Sordelli I, Calise F, et al. Prognosis of patients with spontaneous rupture of hepatocellular carcinoma in cirrhosis. Updates Surg. 2011 Mar; 63 (1):25-30. doi: 10.1007/s13304-010-0041-8. PubMed PMID: 21258886.
Buczkowski AK, Kim PT, Ho SG, et al. Multidisciplinary management of ruptured hepatocellular carcinoma. J Gastrointest Surg. 2006 Mar; 10 (3):379-86. doi: 10.1016/j.gassur.2005.10.012. PubMed PMID: 16504883.
Recordare A, Bonariol L, Caratozzolo E, et al. Management of spontaneous bleeding due to hepatocellular carcinoma. Minerva Chir. 2002 Jun; 57 (3):347-56. PubMed PMID: 12029230.
Castells L, Moreiras M, Quiroga S, et al. Hemoperitoneum as a first manifestation of hepatocellular carcinoma in western patients with liver cirrhosis: effectiveness of emergency treatment with transcatheter arterial embolization. Dig Dis Sci. 2001 Mar; 46 (3):555-62. PubMed PMID: 11318532.
Vivarelli M, Cavallari A, Bellusci R, et al. Ruptured hepatocellular carcinoma: an important cause of spontaneous haemoperitoneum in Italy. Eur J Surg. 1995 Dec; 161 (12):881-6. PubMed PMID: 8775629.
Cherqui D, Panis Y, Rotman N, et al. Emergency liver resection for spontaneous rupture of hepatocellular carcinoma complicating cirrhosis. Br J Surg. 1993 Jun; 80 (6):747-9. PubMed PMID: 8392424.
Bassi N, Caratozzolo E, Bonariol L, et al. Management of ruptured hepatocellular carcinoma: implications for therapy. World J Gastroenterol. 2010 Mar 14; 16 (10):1221-5. PubMed PMID: 20222165; PubMed Central PMCID: PMCPMC2839174.
Kung CT, Liu BM, Ng SH, et al. Transcatheter arterial embolization in the emergency department for hemodynamic instability due to ruptured hepatocellular carcinoma: analysis of 167 cases. AJR Am J Roentgenol. 2008 Dec; 191 (6):W231-9. doi: 10.2214/AJR.07.3983. PubMed PMID: 19020209.
Li WH, Cheuk EC, Kowk PC, et al. Survival after transarterial embolization for spontaneous ruptured hepatocellular carcinoma. J Hepatobiliary Pancreat Surg. 2009; 16 (4):508-12. doi: 10.1007/s00534-009-0094-6. PubMed PMID: 19381430.
Moris D, Chakedis J, Sun SH, et al. Management, outcomes, and prognostic factors of ruptured hepatocellular carcinoma: A systematic review. J Surg Oncol. 2017 Nov 8. doi: 10.1002/jso.24869. PubMed PMID: 29116644.
Llovet JM, Zucman-Rossi J, Pikarsky E, et al. Hepatocellular carcinoma. Nat Rev Dis Primers. 2016 Apr 14; 2:16018. doi: 10.1038/nrdp.2016.18. PubMed PMID: 27158749.
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