Purpose

To compare the feasibility and efficacy of emergency transarterial embolization (TAE) followed by staged hepatectomy (SH) with emergency hepatectomy (EH) for ruptured hepatocellular carcinoma (HCC).

Methods

Between January 2012 and December 2017, 102 patients with HCC rupture received EH or emergency TAE followed by SH in our center. Patients were followed until April 2019. Propensity score matching (PSM) analysis was used at a 1:2 ratio, resulting in 20 patients in the SH group and 40 patients in the EH group. We retrospectively compared the operative variables, recurrence status, disease-free survival (DFS), and overall survival (OS) of patients between the two matched groups.

Results

Compared with the matched EH group, the SH group showed significantly decreased perioperative blood loss or blood transfusion, shortened intraoperative duration of clamping and postoperative hospital stay (P < 0.05), while achieving comparable long-term OS (SH group: 39.0 months vs. EH group: 38.1 months, P = 0.342). There was no significant difference in the peritoneal metastasis rate (SH group: 20.0% vs. EH group: 25.6%, P = 0.874), recurrence rate (SH group: 65.0% vs. EH group: 71.8%, P = 0.333) or DFS (SH group: 9.4 months vs. EH group: 7.7 months, P = 0.602) between the two matched groups.

Conclusion

For resectable ruptured HCC, emergency TAE of rupture which followed by SH, could bring patients about intraoperative and postoperative benefits when compared to EH. Moreover, this combination treatment will not increase the rate of peritoneal metastasis or recurrence, and might achieve favorable survival benefits for patients.

中文翻译：

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急诊经动脉栓塞后再行肝切除术与急诊肝切除术治疗破裂性肝细胞癌：单中心，倾向评分匹配分析。

目的

为了比较破裂性肝细胞癌（HCC）的紧急经动脉栓塞术（TAE）继发分期肝切除术（SH）和紧急肝切除术（EH）的可行性和有效性。

方法

在2012年1月至2017年12月期间，我们中心有102例HCC破裂患者接受了EH或急诊TAE，然后是SH。对患者进行随访直至2019年4月。倾向得分匹配（PSM）分析以1：2的比例使用，SH组为20例，EH组为40例。我们回顾性地比较了两个匹配组之间患者的手术变量，复发状态，无病生存期（DFS）和总生存期（OS）。

结果

与匹配的EH组相比，SH组的围手术期失血或输血明显减少，术中钳夹时间和术后住院时间均显着缩短（P  <0.05），而长期OS则相当（SH组：39.0个月vs. EH组：38.1个月，P  = 0.342）。腹膜转移率（SH组：20.0％vs. EH组：25.6％，P  = 0.874），复发率（SH组：65.0％vs. EH组：71.8％，P  = 0.333）或无明显差异。 两个匹配组之间的DFS（SH组：9.4个月，EH组：7.7个月，P = 0.602）。

结论

对于可切除的破裂性肝癌，与EH相比，急诊TAE破裂再加上SH可为患者带来术中和术后益处。而且，这种联合治疗不会增加腹膜转移或复发的速度，并且可能为患者带来有利的生存益处。