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Emergency transarterial embolization followed by staged hepatectomy versus emergency hepatectomy for ruptured hepatocellular carcinoma: a single-center, propensity score matched analysis

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Abstract

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.

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References

  1. Yoshida H, Mamada Y, Taniai N, et al. Spontaneous ruptured hepatocellular carcinoma. Hepatol Res. 2016;46:13–211.

    Article  PubMed  Google Scholar 

  2. Lai EC, Lau WY. Spontaneous rupture of hepatocellular carcinoma: a systematic review. Arch Surg. 2006;141:191–8.

    Article  PubMed  Google Scholar 

  3. Aoki T, Kokudo N, Matsuyama Y, et al. Prognostic impact of spontaneous tumor rupture in patients with hepatocellular carcinoma: an analysis of 1160 cases from a nationwide survey. Ann Surg. 2014;259:532–42.

    Article  PubMed  Google Scholar 

  4. Vergara V, Muratore A, Bouzari H, et al. Spontaneous rupture of hepatocelluar carcinoma: surgical resection and long-term survival. Eur J Surg Oncol. 2000;26:770–2.

    Article  CAS  PubMed  Google Scholar 

  5. Wu J-j, Zhu P, Zhang Z-g, et al. Spontaneous rupture of hepatocellular carcinoma: Optimal timing of partial hepatectomy. Eur J Surg Oncol. 2019. https://doi.org/10.1016/j.ejso.2019.02.033.

    Article  PubMed  Google Scholar 

  6. Lee HS, Choi GH, Choi JS, et al. Staged partial hepatectomy versus transarterial chemoembolization for the treatment of spontaneous hepatocellular carcinoma rupture : a multicenter analysis in Korea. Ann Surg Treat Res. 2019;96:275–82.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Ou D, Yang H, Zeng Z, et al. Comparison of the prognostic influence of emergency hepatectomy and staged hepatectomy in patients with ruptured hepatocellular carcinoma. Digest Liver Dis. 2016;48:934–9.

    Article  Google Scholar 

  8. Kirikoshi H, Saito S, Yoneda M, et al. Outcomes and factors influencing survival in cirrhotic cases with spontaneous rupture of hepatocellular carcinoma: a multicenter study. BMC Gastroenterol. 2009;9:29.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Portolani N, Baiocchi G, Gheza F, et al. Parietal and peritoneal localizations of hepatocellular carcinoma: is there a place for a curative surgery? World J Surg Oncol. 2014;12:1–7.

    Article  Google Scholar 

  10. Zhang W, Zhang ZW, Zhang BX, et al. Outcomes and prognostic factors of spontaneously ruptured hepatocellular carcinoma. J Gastrointest Surg. 2018. https://doi.org/10.1007/s11605-018-3930-7.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Ren A, Luo S, Ji L, et al. Peritoneal metastasis after emergency hepatectomy and delayed hepatectomy for spontaneous rupture of hepatocellular carcinoma. Asian J Surg. 2019;42:464–9.

    Article  PubMed  Google Scholar 

  12. Yang T, Zhang J, Lu JH, et al. A new staging system for resectable hepatocellular carcinoma: comparison with six existing staging systems in a large Chinese cohort. J Cancer Res Clin. 2011;137:739–50.

    Article  Google Scholar 

  13. Zhou C, Zu QQ, Wang B, et al. Efficacy and prognostic factors of transarterial embolization as initial treatment for spontaneously ruptured hepatocellular carcinoma: a single-center retrospective analysis in 57 patients. Jpn J Radiol. 2019;37:255–63.

    Article  CAS  PubMed  Google Scholar 

  14. Kim JY, Lee JS, Oh DH, et al. Transcatheter arterial chemoembolization confers survival benefit in patients with a spontaneously ruptured hepatocellular carcinoma. Eur J Gastroenterol Hepatol. 2012;24:640–5.

    Article  PubMed  Google Scholar 

  15. Monroe EJ, Kogut MJ, Ingraham CR, et al. Outcomes of emergent embolisation of ruptured hepatocellular carcinoma in a western population. Clin Radiol. 2015;70:730–5.

    Article  CAS  PubMed  Google Scholar 

  16. Yeh CN, Chen MF. Resection of peritoneal implantation of hepatocellular carcinoma after hepatic resection: risk factors and prognostic analysis. World J Surg. 2004;28:382–6.

    Article  PubMed  Google Scholar 

  17. Li J, Huang L, Liu CF, et al. Risk factors and surgical outcomes for spontaneous rupture of BCLC stages A and B hepatocellular carcinoma: A case-control study. World J Gastroentero. 2014;20:9121–7.

    Google Scholar 

  18. Yang T, Sun YF, Zhang J, et al. Partial hepatectomy for ruptured hepatocellular carcinoma. Brit J Surg. 2013;100:1071–9.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

We would like to thank Dr. Roberto Kutcher from the University of Massachusetts for his English language editing.

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Correspondence to Sheng Liu.

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Zhou, C., Zhang, C., Zu, QQ. et al. Emergency transarterial embolization followed by staged hepatectomy versus emergency hepatectomy for ruptured hepatocellular carcinoma: a single-center, propensity score matched analysis. Jpn J Radiol 38, 1090–1098 (2020). https://doi.org/10.1007/s11604-020-01007-2

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