Clinical Experience with Hepatic Resection for a Ruptured Hepatocellular Carcinoma

Kim, Woo Young; Lee, Sung Gyu; Lee, Young Joo; Park, Kwang Min; Jeon, Hoon Bae; Hwang, Shin; Min, Pyung Chul

Abstract

Spontaneous rupture of a hepatocellular carcinoma (HCC) is an uncommon but fatal complication of this disease. Hepatic resection provides the only hope of cure for patients with a ruptured HCC. However, reports on hepatectomies for ruptured HCCs are sparse in Korea, so we reviewed our clinical experience with hepatic resection for this potentially fatal complication. Nine cases of ruptured HCCs were treated by hepatectomies at our department between April 1990 and January 1997. The results of the clinical review are as follows: 1) The incidence of spontaneous rupture to all HCCs was 4.4%. Ages ranged from 36 to 75 years with a mean age of 50.6 years, and sex ratio was 3.5 : 1 with a male predominance. 2) Most patients (7 cases, 78%) had right upper quadrant abdominal pain and/or epigastralgia with a duration of 3 hours to 1 month. Two cases were presented in a state of hemorrhagic shock. 3) HBsAg was positive in all cases, and the level of the alpha-fetoprotein was more than 10,000mg/ml in 5 cases. 4) Liver cirrhosis was presented in 7 cases (78%) 5) The site of the rupture was the right lobe in 4 cases (44%) and the left lobe in 5 cases (56%) 7) The types of hepatectomies included a right lobectomy in 2 cases, a left lobectomy in 2 cases, a left lateral segmentectomy in 2 cases and a partial hepatectomy in 3 cases. 8) Complete removal of the tumor was carried out in 6 cases, and palliative resection was performed in 3 cases. 9) Overall 1-year and 2-year cumulative survival rates were 64% and 43%, respectively. In conclusion, Hepatic resection is considered to be the treatment of choice for a ruptured HCC, and long-term survival can be observed in a few patients with ruptured HCCs who underwent curative resections.