Ann Surg Treat Res.  2019 Dec;97(6):291-295. 10.4174/astr.2019.97.6.291.

Intraoperative radiofrequency ablation and distilled water peritoneal lavage for spontaneously ruptured hepatocellular carcinoma

• Kwak BJ
• Park J
• Kwon YK
• Kwon JH
• Yoon YC

• KMID: 2464784
• DOI: http://doi.org/10.4174/astr.2019.97.6.291

Abstract

PURPOSE
Spontaneously ruptured hepatocellular carcinoma (srHCC) is known to be a life-threatening complication with poor prognosis. Although there are various treatment modalities, there is no definite treatment guideline. The purpose of this study was to review the surgical outcome and prognosis of srHCC treated with intraoperative radiofrequency ablation (RFA) and distilled water peritoneal lavage (DWPL).
METHODS
From March 2012 to October 2018, 9 patients with srHCC who underwent emergent surgery were reviewed. After hematoma removal, intraoperative RFA and DWPL were applied to all patients. Hepatectomy was performed if necessary. Patients with multiple tumors, distant metastasis, and vascular tumor involvement in radiologic imaging were excluded.
RESULTS
Six of 9 patients with diameters less than 7 cm were able to obtain hemostasis using RFA alone (RFA group). However, 3 patients with a tumor size of more than 10 cm underwent liver resection because they could not obtain hemostasis with RFA (hepatectomy only group). The RFA group had shorter operation time (148.3 ± 31.7 minutes vs. 251.7 ± 20.2 minutes, P < 0.05) and less red blood cell transfusion (5.8 ± 2.5 packs vs. 24.0 ± 11.5 packs, P < 0.05) than the hepatectomy only group. There was no peritoneal metastasis at long-term follow-up in the RFA group. Five-year recurrence-free survival rate was 0% in both groups. However, 5-year overall survival rate was better in the RFA group (83.3% vs. 0%, P < 0.05).
CONCLUSION
Intraoperative RFA and DWPL are easy to perform and theoretically the best methods for managing relatively small srHCC.

Keyword

Hepatocellular carcinoma; Peritoneal lavage; Prognosis; Radiofrequency ablation; Rupture

MeSH Terms

Carcinoma, Hepatocellular*
Catheter Ablation*
Erythrocyte Transfusion
Follow-Up Studies
Hematoma
Hemostasis
Hepatectomy
Humans
Liver
Neoplasm Metastasis
Peritoneal Lavage*
Prognosis
Rupture
Survival Rate
Water*
Water

Figure

• 

  Fig. 1 Intraoperative findings of a patient who underwent radiofrequency ablation after hematoma removal.

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  Fig. 2 Cumulative recurrence-free survival (A) and overall survival (B) after spontaneous ruptured hepatocellular carcinoma in the radiofrequency ablation (RFA) and hepatectomy only groups. There was no significant difference in recurrence-free survival between these 2 groups (P = 0.186). However, there were significant differences in overall survival between these 2 groups (P < 0.05).

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