Management of spontaneous ruptured hepatocellular carcinoma
10.3760/cma.j.issn.1673-9752.2020.02.001
- VernacularTitle:自发性肝细胞癌破裂的处理策略
- Author:
Yee Wan LAU
1
Author Information
1. 中华人民共和国香港特别行政区新界沙田香港中文大学医学院
- From:
Chinese Journal of Digestive Surgery
2020;19(2):113-118
- CountryChina
- Language:Chinese
-
Abstract:
The incidences of hepatocellular carcinoma (HCC) and ruptured HCC differ significantly in different countries and regions of the world. Ruptured HCC has a very high mortality rate, although the underlying mechanisms why it occurs remain controversial. The diagnosis of ruptured HCC is made based on clinical and imaging examinations. Management of ruptured HCC can be divided into 3 phases. Phase 1: the emergency phase. The treatment aims are to stabilize the patient and stop bleeding by resuscitation.Methodswhich can be used to stop bleeding include correction of coagulopathies, interventional therapy (transarterial embolization) and surgery (including perihepatic packing, hepatic artery ligation, application of energy source or direct injection of ethanol, or even emergency partial hepatectomy). Phase 2: the assessment phase. After the bleeding has been stopped, the next phase is assessment, which includes assessing the general condition of patients, liver function, tumor staging, resectability of tumor, volume of future liver remnant, comorbidity and association with cirrhosis and/or portal hypertension. Phase 3: definitive treatment phase. The definitive treatment can be divided into curative and non-curative treatments. As ruptured HCC is a contraindication to liver transplantation, the only available curative treatment is partial hepatectomy. There is evidence to show that peritoneal irrigation with water or 5-FU during partial hepatectomy for ruptured HCC can reduce the rate of tumor implantation. The timing of partial hepatectomy can be emergency (during the rupture time), early delayed (within 8 days of HCC rupture) or late delayed (>8 days of HCC rupture). Evidence is emerging that partial hepatectomy carried out in the emergency or early delayed period has a lower incidence of peritoneal tumor implantation and metastasis compared with the late delayed period to carry out partial hepatectomy. After the bleeding stopped in patients with ruptured HCC, the treatment of patients with unresectable HCC would be similar to those with non-ruptured HCC. In patients with resectable HCC, high level evidences are emerging to show that partial hepatectomy can result in better long-term survival compared with any form of non-surgical treatments, including transcatheter arterial chemoembolization and transarterial radioembolization.
