Lilian Schwarz1,2, Michael Bubenheim3, Johanna Zemour4, Astrid Herrero5, Fabrice Muscari6, Ahmet Ayav7, Romain Riboud8, Christian Ducerf9, J-Marc Regimbeau10, Hadrien Tranchart11, Emilie Lermite12, Gheorghe Petrovai13, Amal Suhol14, Alexandre Doussot15, Lorenzo Capussotti16, Jean Jacques Tuech17,18, Yves Patrice Le Treut4. 1. Department of Digestive Surgery, Hôpital Charles Nicolle, Rouen University Hospital, Rouen, France. lilian.schwarz@chu-rouen.fr. 2. Normandie University, UNIROUEN, Inserm U1245, Team 3, IRON group, Rouen University Hospital, Normandy Centre for Genomic and Personalized Medicine, 76000, Rouen, France. lilian.schwarz@chu-rouen.fr. 3. Department of Biostatistics, Hôpital Charles Nicolle, Rouen University Hospital, Rouen, France. 4. Department of General Surgery and Liver Transplantation, APHM, Hôpital de la Conception, Marseille University Hospital, Marseille, France. 5. Department of Digestive Surgery, Hôpital Saint Eloi, Montpellier University Hospital, Montpellier, France. 6. Department of Digestive Surgery and Liver Transplantation, Hôpital Rangueil, Toulouse University Hospital, Toulouse, France. 7. Department of HPB Surgery, Nancy University Hospital, Nancy, France. 8. Department of Emergency and Digestive Surgery, Grenoble University Hospital, Grenoble, France. 9. Department of Digestive Surgery and Liver Transplantation, Hôpital de la Croix Rousse, Lyon University Hospital, Lyon, France. 10. Department of Digestive Surgery, Hôpital Nord, Amiens University Hospital, Amiens, France. 11. Department of Minimally Invasive Surgery, Hôpital Antoine Béclère, Clamart, France. 12. Department of digestive Surgery, Angers University Hospital, Angers, France. 13. Department of Digestive Surgery and Liver Transplantation, Hôpital Huriez, Nord-de-France University Hospital, Lille, France. 14. Department of Digestive Surgery and Liver Transplantation, Hôpital La Pitié Salpétrière, APHP, Paris, France. 15. Department of Digestive Surgery, Dijon University Hospital, Dijon, France. 16. Department of HPB and Digestive Surgery, Ospedale Mauriziano Umberto, Turin, Italy. 17. Department of Digestive Surgery, Hôpital Charles Nicolle, Rouen University Hospital, Rouen, France. 18. Normandie University, UNIROUEN, Inserm U1245, Team 3, IRON group, Rouen University Hospital, Normandy Centre for Genomic and Personalized Medicine, 76000, Rouen, France.
Abstract
BACKGROUND: The incidence of spontaneous rupture of hepatocellular carcinoma (HCC) is low in Europe, at less than 3%. HCC rupture remains a life-threatening complication, with mortality reported between 16 and 30%. The risk of bleeding recurrence has never been clearly evaluated in such clinical situation. The objectives of this study were to evaluate the current risk of mortality related to HCC rupture and to focus on the risk of bleeding recurrence following interventional management. METHODS: All patients admitted to 14 French-Italian surgical centers for spontaneous rupture of HCC between May 2000 and May 2012 were retrospectively included. Clinical data, imaging features, relevant laboratory data, treatment strategies, and prognoses were analyzed. RESULTS: Overall, 58 of the 138 included patients (42%) had cirrhosis. Thirty-five patients (25%) presented with hemorrhagic shock, and 19% with organ(s) dysfunction. Bleeding control was obtained by interventional hemostasis, emergency liver resection, and conservative medical management in 86 (62%), 24 (18%), and 21 (15%) patients, respectively. Best supportive care was chosen for 7 (5%) patients. The mortality rate following rupture was 24%. The bleeding recurrence rate was 22% with related mortality of 52%. In multivariate analysis, a bilirubin level >17 micromol/L (HR 3.768; p = 0.006), bleeding recurrence (HR 5.400; p < 0.0001), and ICU admission after initial management (HR 8.199; p < 0.0001) were associated with in-hospital mortality. CONCLUSION: This European, multicenter, large-cohort study confirmed that the prognosis of ruptured HCC is poor with an overall mortality rate of 24%, despite important advances in endovascular techniques. Overall, the rate of bleeding recurrence was more than 20%, with a related high risk of mortality.
BACKGROUND: The incidence of spontaneous rupture of hepatocellular carcinoma (HCC) is low in Europe, at less than 3%. HCC rupture remains a life-threatening complication, with mortality reported between 16 and 30%. The risk of bleeding recurrence has never been clearly evaluated in such clinical situation. The objectives of this study were to evaluate the current risk of mortality related to HCC rupture and to focus on the risk of bleeding recurrence following interventional management. METHODS: All patients admitted to 14 French-Italian surgical centers for spontaneous rupture of HCC between May 2000 and May 2012 were retrospectively included. Clinical data, imaging features, relevant laboratory data, treatment strategies, and prognoses were analyzed. RESULTS: Overall, 58 of the 138 included patients (42%) had cirrhosis. Thirty-five patients (25%) presented with hemorrhagic shock, and 19% with organ(s) dysfunction. Bleeding control was obtained by interventional hemostasis, emergency liver resection, and conservative medical management in 86 (62%), 24 (18%), and 21 (15%) patients, respectively. Best supportive care was chosen for 7 (5%) patients. The mortality rate following rupture was 24%. The bleeding recurrence rate was 22% with related mortality of 52%. In multivariate analysis, a bilirubin level >17 micromol/L (HR 3.768; p = 0.006), bleeding recurrence (HR 5.400; p < 0.0001), and ICU admission after initial management (HR 8.199; p < 0.0001) were associated with in-hospital mortality. CONCLUSION: This European, multicenter, large-cohort study confirmed that the prognosis of ruptured HCC is poor with an overall mortality rate of 24%, despite important advances in endovascular techniques. Overall, the rate of bleeding recurrence was more than 20%, with a related high risk of mortality.
Authors: V Vergara; A Muratore; H Bouzari; R Polastri; A Ferrero; G Galatola; L Capussotti Journal: Eur J Surg Oncol Date: 2000-12 Impact factor: 4.424
Authors: David F Pinal-García; Carlos M Nuño-Guzmán; Audrey Gómez-Abarca; Jorge L Corona; Ismael Espejo Journal: Case Rep Gastroenterol Date: 2018-01-17