Edouard Roussel1, Michael Bubenheim2, Yves-Patrice Le Treut3, Alexis Laurent4, Astrid Herrero5, Fabrice Muscari6, Jean-Yves Mabrut7, Eric Savier8, Emmanuel Boleslawski9, Ahmet Ayav10, Emilie Lermite11, Alexandre Doussot12, Jean-Marc Regimbeau13, Romain Riboud14, Daniel Cherqui15, Lilian Schwarz16,17. 1. Department of Digestive Surgery, Hôpital Charles Nicolle, Rouen University Hospital, Rouen Cedex, France. 2. Department of Biostatistics, Hôpital Charles Nicolle, Rouen University Hospital, Rouen, France. 3. Department of General Surgery and Liver Transplantation, APHM, Hôpital de la Conception, Marseille University Hospital, Marseille, France. 4. Department of Digestive, Hepatobiliary, Pancreatic Surgery and Liver Transplantation, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, 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 Digestive Surgery and Liver Transplantation, Hôpital de la Croix-Rousse, Lyon University Hospital, Lyon, France. 8. Department of Digestive Surgery and Liver Transplantation, Hôpital La Pitié Salpétrière, Assistance Publique-Hôpitaux de Paris, Paris, France. 9. Department of Digestive Surgery and Liver Transplantation, Hôpital Huriez, Nord-de-France University Hospital, Lille, France. 10. Department of HPB Surgery, Nancy University Hospital, Nancy, France. 11. Department of Digestive Surgery, Angers University Hospital, Angers, France. 12. Department of Digestive Surgery, Dijon University Hospital, Dijon, France. 13. Department of Digestive Surgery, Hôpital Nord, Amiens University Hospital, Amiens, France. 14. Department of Emergency and Digestive Surgery, Grenoble University Hospital, Grenoble, France. 15. Department of Hepatobiliary and Liver Transplantation, Paul Brousse University Hospital, Assistance Publique-Hôpitaux de Paris, Villejuif, France. 16. Department of Digestive Surgery, Hôpital Charles Nicolle, Rouen University Hospital, Rouen Cedex, France. lilian.SCHWARZ@gmail.com. 17. Department of Genomic and Personalized Medicine in Cancer and Neurological Disorders, Normandie Univ, UNIROUEN, UMR 1245 INSERM, Rouen University Hospital, Rouen, France. lilian.SCHWARZ@gmail.com.
Abstract
BACKGROUND: Spontaneous rupture of hepatocellular carcinoma (HCC) remains a life-threatening complication, with a reported mortality rate of between 16 and 30% and an incidence rate of approximately 3% in Europe. Survival data and risk factors after ruptured HCC are lacking, especially for peritoneal metastasis (PM). OBJECTIVES: The aims of this study were to evaluate the pattern of recurrence and mortality after hepatectomy for ruptured HCC, and to focus on PM. METHODS: We retrospectively reviewed the files of patients admitted to 14 French surgical centers for spontaneous rupture of HCC between May 2000 and May 2012. RESULTS: Overall, 135 patients were included in this study. The median disease-free survival and overall survival (OS) rates were 16.1 (11.0-21.1) and 28.7 (26.0-31.5) months, respectively, and the median follow-up period was 29 months. At last follow-up, recurrences were observed in 65.1% of patients (n = 88). The overall rate of PM following ruptured HCC was 12% (n = 16). Surgical management of PM was performed for six patients, with a median OS of 36.6 months. An α-fetoprotein level > 30 ng/mL (p = 0.0009), tumor size at rupture > 70 mm (p = 0.0009), and vascular involvement (p < 0.0001) were found to be independently associated with an increased likelihood of recurrence. No risk factor for PM was observed. CONCLUSION: This large-cohort French study confirmed that 12% of patients had PM after ruptured HCC. A curative approach may be an option for highly selected patients with exclusive PD because of the survival benefit it could provide.
BACKGROUND:Spontaneous rupture of hepatocellular carcinoma (HCC) remains a life-threatening complication, with a reported mortality rate of between 16 and 30% and an incidence rate of approximately 3% in Europe. Survival data and risk factors after ruptured HCC are lacking, especially for peritoneal metastasis (PM). OBJECTIVES: The aims of this study were to evaluate the pattern of recurrence and mortality after hepatectomy for ruptured HCC, and to focus on PM. METHODS: We retrospectively reviewed the files of patients admitted to 14 French surgical centers for spontaneous rupture of HCC between May 2000 and May 2012. RESULTS: Overall, 135 patients were included in this study. The median disease-free survival and overall survival (OS) rates were 16.1 (11.0-21.1) and 28.7 (26.0-31.5) months, respectively, and the median follow-up period was 29 months. At last follow-up, recurrences were observed in 65.1% of patients (n = 88). The overall rate of PM following ruptured HCC was 12% (n = 16). Surgical management of PM was performed for six patients, with a median OS of 36.6 months. An α-fetoprotein level > 30 ng/mL (p = 0.0009), tumor size at rupture > 70 mm (p = 0.0009), and vascular involvement (p < 0.0001) were found to be independently associated with an increased likelihood of recurrence. No risk factor for PM was observed. CONCLUSION: This large-cohort French study confirmed that 12% of patients had PM after ruptured HCC. A curative approach may be an option for highly selected patients with exclusive PD because of the survival benefit it could provide.