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Impact of Spontaneous Hepatocellular Carcinoma Rupture on Recurrence Pattern and Long-term Surgical Outcomes after Partial Hepatectomy

Authors
 Hyung Soon Lee  ;  Gi Hong Choi  ;  Dae Ryong Kang  ;  Kwang-Hyub Han  ;  Sang Hoon Ahn  ;  Do Young Kim  ;  Jun Yong Park  ;  Seung Up Kim  ;  Jin Sub Choi 
Citation
 WORLD JOURNAL OF SURGERY, Vol.38(8) : 2070-2078, 2014 
Journal Title
WORLD JOURNAL OF SURGERY
ISSN
 0364-2313 
Issue Date
2014
MeSH
Adult ; Aged ; Carcinoma, Hepatocellular/secondary ; Carcinoma, Hepatocellular/surgery* ; Embolization, Therapeutic/methods ; Female ; Hepatectomy/adverse effects ; Hepatectomy/methods* ; Humans ; Kaplan-Meier Estimate ; Liver Neoplasms/surgery* ; Male ; Middle Aged ; Neoplasm Recurrence, Local/etiology ; Prognosis ; Propensity Score ; Retrospective Studies ; Rupture, Spontaneous/complications ; Rupture, Spontaneous/surgery ; Treatment Outcome
Keywords
Overall Survival ; Tace ; Recurrence Pattern ; Liver Functional Reserve ; Resectable Tumor Group
Abstract
BACKGROUND:
The clinical significance of spontaneous hepatocellular carcinoma (HCC) rupture association with recurrence pattern and long-term surgical outcomes remains under debate. We investigated the impact of spontaneous HCC rupture on recurrence pattern and long-term surgical outcomes after partial hepatectomy.
METHODS:
From 2000 to 2012, 119 patients with diagnosed ruptured HCC were reviewed. To compare outcomes between staged hepatectomy in spontaneously ruptured HCC and hepatectomy in non-ruptured HCC, we performed propensity score-matching to adjust for significant differences in patient characteristics. Overall survival, disease-free survival, and recurrence pattern were compared between the matched groups.
RESULTS:
Forty-four patients with newly diagnosed ruptured HCC and Child A class were initially treated with transcatheter arterial embolization for hemostasis. Three patients underwent emergency laparotomy, 18 underwent staged hepatectomy, and 23 received transarterial chemoembolization (TACE) alone after transcatheter arterial embolization. Among the 23 patients treated with TACE alone, 10 had resectable tumors. The staged hepatectomy group shows significantly higher overall survival with TACE alone than the resectable tumor group (P < 0.001). After propensity score-matching, overall survival, disease-free survival, and recurrence pattern were not significantly different between the ruptured HCC with staged hepatectomy group and the non-ruptured HCC with hepatectomy group. Peritoneal recurrence rates were similar at 14.3% versus 10.0%, respectively (P = 0.632).
CONCLUSIONS:
Patients with spontaneously ruptured HCC with staged hepatectomy show comparable long-term survival and recurrence pattern as patients with non-ruptured HCC having similar tumor characteristics and liver functional status. Thus, spontaneous HCC rupture may not increase peritoneal recurrence and decrease long-term survival after partial hepatectomy.
Full Text
http://link.springer.com/article/10.1007%2Fs00268-014-2502-6
DOI
10.1007/s00268-014-2502-6
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Preventive Medicine (예방의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Yonsei Biomedical Research Center (연세의생명연구원) > 1. Journal Papers
Yonsei Authors
Kang, Dae Ryong(강대용)
Kim, Do Young(김도영)
Kim, Seung Up(김승업) ORCID logo https://orcid.org/0000-0002-9658-8050
Park, Jun Yong(박준용) ORCID logo https://orcid.org/0000-0001-6324-2224
Ahn, Sang Hoon(안상훈) ORCID logo https://orcid.org/0000-0002-3629-4624
Lee, Hyung Soon(이형순)
Choi, Gi Hong(최기홍) ORCID logo https://orcid.org/0000-0002-1593-3773
Choi, Jin Sub(최진섭)
Han, Kwang-Hyub(한광협) ORCID logo https://orcid.org/0000-0003-3960-6539
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/99089
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