Skip to main content
Log in

Long-term results of elective hepatectomy for the treatment of ruptured hepatocellular carcinoma

  • Original Article
  • Published:
Journal of Hepato-Biliary-Pancreatic Surgery

Abstract

Background/Purpose

According to the General rules for the clinical and pathological study of primary liver cancer, compiled by the Liver Cancer Study Group of Japan, ruptured hepatocellular carcinoma (HCC) is classified as stage 4, even if the tumor is small and solitary. We examined the long-term results of elective hepatectomy for the treatment of ruptured HCC.

Methods

A first hepatectomy was performed without operative death in 193 patients with HCC. Ten patients had ruptured HCC (ruptured group) and 183 patients had nonruptured HCC (nonruptured group). The extension of HCC was macroscopically classified as stage 1 in 23 patients, stage 2 in 71, stage 3 in 53, and stage 4 in 46.

Results

Cumulative survival rates in the ruptured group at 1, 5, and 10 years were 90.0%, 67.5%, and 20.3%, respectively. The cumulative survival rate was lower in patients with stage 4 disease in the nonruptured group than that in patients in the ruptured group (P < 0.05). Cumulative survival rates did not differ significantly between patients in the ruptured group and those with stage 2 or stage 3 disease.

Conclusions

Survival rates after elective hepatectomy in patients with ruptured HCC are good, even if the disease is classified as stage 4.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Chen CY, Lin XZ, Shin JS, Lin CY, Leow TC, Chen CY, Chang TT. Spontaneous rupture of hepatocellular carcinoma: a review of 141 Taiwanese cases and comparison with nonrupture cases. J Clin Gastroenterol 1995;21:238–242.

    Article  PubMed  CAS  Google Scholar 

  2. Lai EC, Wu KM, Choi TK, Fan ST, Wong J. Spontaneous ruptured hepatocellular carcinoma: an appraisal of surgical treatment. Ann Surg 1989;210:24–28.

    Article  PubMed  CAS  Google Scholar 

  3. Dewar GA, Griffin SM, Ku KW, Lau WY, Li AK. Management of bleeding liver tumours in Hong Kong. Br J Surg 1991;78:463–466.

    Article  PubMed  CAS  Google Scholar 

  4. Yoshida H, Onda M, Tajiri T, Umehara M, Mamada Y, Matsumoto S, et al. Treatment of spontaneous ruptured hepatocellular carcinoma. Hepatogastroenterology 1999;46:2451–2453.

    PubMed  CAS  Google Scholar 

  5. Sobin LH, Wittekind CH. TNM classification of malignant tumours. 6th ed. New York: Wiley; 2002. p. 81–83.

    Google Scholar 

  6. Liver Cancer Study Group of Japan. The general rules for the clinical and pathological study of primary liver cancer. Tokyo: Kanehara; 1992.

    Google Scholar 

  7. Yoshida H, Onda M, Tajiri T, Akimaru K, Takasaki H, Mamada Y, et al. Successful surgical treatment of peritoneal dissemination of hepatocellular carcinoma. Hepatogastroenterology 2002;49:1663–1665.

    PubMed  Google Scholar 

  8. Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg 1973;60:646–649.

    Article  PubMed  CAS  Google Scholar 

  9. Zhu LX, Wang GS, Fan ST. Spontaneous rupture of hepatocellular carcinoma. Br J Surg 1996;83:602–607.

    Article  PubMed  CAS  Google Scholar 

  10. Chen M, Yan Y, Lee T. Transcatheter hepatic arterial embolization followed by hepatic resection for spontaneous rupture of hepatocellular carcinoma. Cancer 1986;58:332–335.

    Article  PubMed  CAS  Google Scholar 

  11. Vivarelli M, Cavallari A, Bellusci R, De Raffele E, Nardo B, Gozzetti G. Ruptured hepatocellular carcinoma: an important cause of spontaneous haemoperitoneum in Italy. Eur J Surg 1995;161:881–886.

    PubMed  CAS  Google Scholar 

  12. Sato Y, Fujiwara K, Furui S, Ogata I, Oka Y, Hayashi S, et al. Benefit of transcatheter arterial embolization for ruptured hepatocellular carcinoma complicating liver cirrhosis. Gastroenterology 1985;89:157–159.

    PubMed  CAS  Google Scholar 

  13. Yamagata M, Maeda T, Ikeda Y, Shirabe K, Nishizaki T, Koyanagi N. Surgical results of spontaneously ruptured hepatocellular carcinoma. Hepatogastroenterology 1995;42:461–464.

    PubMed  CAS  Google Scholar 

  14. Cherqui D, Panis Y, Rotman N, Fagniez PL. Emergency liver resection for spontaneous rupture of hepatocellular carcinoma complicating cirrhosis. Br J Surg 1993;80:747–749.

    Article  PubMed  CAS  Google Scholar 

  15. Okazaki M, Higashihara H, Koganemaru F, Nakamura T, Kitsuki H, Hoashi T, Makuuchi M. Intraperitoneal hemorrhage from hepatocellular carcinoma: emergency chemoembolization or embolization. Radiology 1991;180:647–651.

    PubMed  CAS  Google Scholar 

  16. Nouchi T, Nishimura M, Maeda M, Funatsu T, Hasumura Y, Takeuchi J. Transcatheter arterial embolization of ruptured hepatocellular carcinoma associated with liver cirrhosis. Dig Dis Sci 1984;29:1137–1141.

    Article  PubMed  CAS  Google Scholar 

  17. Hsieh JS, Huang CJ, Huang YS, Sheen PC, Huang TJ. Intraperitoneal hemorrhage due to spontaneous rupture of hepatocellular carcinoma: treatment by hepatic artery embolization. Am J Roentgenol AJR 1987;149:715–717.

    CAS  Google Scholar 

  18. Miyamoto M, Sudo T, Kuyama T. Spontaneous rupture of hepatocellular carcinoma: a review of 172 Japanese cases. Am J Gastroenterol 1991;86:67–71.

    PubMed  CAS  Google Scholar 

  19. Belghiti J, Ogata S. Assessment of hepatic reserve for the indication of hepatic resection. J Hepatobiliary Pancreat Surg 2005;12:1–3.

    Article  PubMed  Google Scholar 

  20. Lodge JP. Assessment of hepatic reserve for the indication of hepatic resection: how I do it. J Hepatobiliary Pancreat Surg 2005;12:4–9.

    Article  PubMed  Google Scholar 

  21. Bennett JJ, Blumgart LH. Assessment of hepatic reserve prior to hepatic resection. J Hepatobiliary Pancreat Surg 2005;12:10–15.

    Article  PubMed  Google Scholar 

  22. Imamura H, Sano K, Sugawara Y, Kokudo N, Makuuchi M. Assessment of hepatic reserve for indication of hepatic resection: decision tree incorporating indocyanine green test. J Hepatobiliary Pancreat Surg 2005;12:16–22.

    Article  PubMed  Google Scholar 

  23. Lee WC, Chen MF. Assessment of hepatic reserve for indication of hepatic resection: how I do it. J Hepatobiliary Pancreat Surg 2005;12:23–26.

    Article  PubMed  Google Scholar 

  24. Gazzaniga GM, Cappato S, Belli FE, Bagarolo C, Filauro M. Assessment of hepatic reserve for the indication of hepatic resection: how I do it. J Hepatobiliary Pancreat Surg 2005;12:27–30.

    Article  PubMed  Google Scholar 

  25. Poon RT, Fan ST. Assessment of hepatic reserve for indication of hepatic resection: how I do it. J Hepatobiliary Pancreat Surg 2005;12:31–37.

    Article  PubMed  Google Scholar 

  26. Lee SG, Hwang S. How I do it: assessment of hepatic functional reserve for indication of hepatic resection. J Hepatobiliary Pancreat Surg 2005;12:38–43.

    Article  PubMed  Google Scholar 

  27. Nagashima I, Takada T, Okinaga K, Nagawa H. A scoring system for the assessment of the risk of mortality after partial hepatectomy in patients with chronic liver dysfunction. J Hepatobiliary Pancreat Surg 2005;12:44–48.

    Article  PubMed  Google Scholar 

  28. Shimada R, Imamura H, Makuuchi M, Soeda J, Kobayashi A, Noike T, Miyagawa S, Kawasaki S. Staged hepatectomy after emergency transcatheter arterial embolization for ruptured hepatocellular carcinoma. Surgery 1998;124:526–535.

    PubMed  CAS  Google Scholar 

  29. The Cancer of the Liver Italian Program (CLIP) Investigators. A new prognostic system for hepatocellular carcinoma: a retrospective study of 435 patients. Hepatology 1998;28:751–755.

    Article  Google Scholar 

  30. Kudo M, Chung H, Osaki Y. Prognostic staging system for hepatocellular carcinoma (CLIP score): its value and limitations, and a proposal for a new staging system, the Japan Integrated Staging Score (JIS score). J Gastroenterol 2003;38:207–215.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

About this article

Cite this article

Yoshida, H., Mamada, Y., Taniai, N. et al. Long-term results of elective hepatectomy for the treatment of ruptured hepatocellular carcinoma. J Hepatobiliary Pancreat Surg 15, 178–182 (2008). https://doi.org/10.1007/s00534-007-1239-0

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00534-007-1239-0

Key words

Navigation