Skip to main content
PMC home page
Annals of Surgery logoLink to Annals of Surgery
. 1989 Jul;210(1):24–28. doi: 10.1097/00000658-198907000-00004

Spontaneous ruptured hepatocellular carcinoma. An appraisal of surgical treatment.

E C Lai 1, K M Wu 1, T K Choi 1, S T Fan 1, J Wong 1
PMCID: PMC1357761  PMID: 2545172

Abstract

Spontaneous rupture with bleeding is not an infrequent complication of hepatocellular carcinoma (HCC). From May, 1972 to January, 1987, 56 symptomatic patients with ruptured HCC were managed by plication of the lesion (2 patients), ligation of either the common hepatic artery, CHAL, (39 patients), or selectively, the arterial branch supplying the tumor-bearing lobe of liver, SHAL, (8 patients), and hepatic resection, HR, (7 patients). Effective hemostasis was achieved in 68.1% of patients with the use of hepatic artery ligation (HAL). SHAL provides a comparable control of bleeding but no demonstrable reduction of postoperative organ failure when compared with CHAL. The operative treatment employed had no influence on either the postoperative rates of morbidity, mortality, or survival. However, the rate of hospital mortality was high among the four patients who had emergency anatomical lobectomy, despite the absence of severe cirrhosis. Hepatic artery ligation, either CHAL or SHAL, is a satisfactory definitive hemostatic measure for unresectable HCC when it ruptured. SHAL is probably preferred to routine emergency HR for patients with potentially resectable lesions. Nonetheless, for selected patients with easily accessible lesions, segmentectomy or subsegmentectomy could still be contemplated in the absence of severe cirrhosis.

Full text

PDF
24

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. BREEDIS C., YOUNG G. The blood supply of neoplasms in the liver. Am J Pathol. 1954 Sep-Oct;30(5):969–977. [PMC free article] [PubMed] [Google Scholar]
  2. Balasegaram M. Spontaneous intraperitoneal rupture of primary liver-cell carcinoma. Aust N Z J Surg. 1968 May;37(4):332–337. [PubMed] [Google Scholar]
  3. Blamey S. L., Fearon K. C., Gilmour W. H., Osborne D. H., Carter D. C. Prediction of risk in biliary surgery. Br J Surg. 1983 Sep;70(9):535–538. doi: 10.1002/bjs.1800700910. [DOI] [PubMed] [Google Scholar]
  4. Chearanai O., Plengvanit U., Asavanich C., Damrongsak D., Sindhvananda K., Boonyapisit S. Spontaneous rupture of primary hepatoma: report of 63 cases with particular reference to the pathogenesis and rationale treatment by hepatic artery ligation. Cancer. 1983 Apr 15;51(8):1532–1536. doi: 10.1002/1097-0142(19830415)51:8<1532::aid-cncr2820510829>3.0.co;2-3. [DOI] [PubMed] [Google Scholar]
  5. Chen M. F., Jan Y. Y., Lee T. Y. Transcatheter hepatic arterial embolization followed by hepatic resection for the spontaneous rupture of hepatocellular carcinoma. Cancer. 1986 Jul 15;58(2):332–335. doi: 10.1002/1097-0142(19860715)58:2<332::aid-cncr2820580221>3.0.co;2-u. [DOI] [PubMed] [Google Scholar]
  6. Hermann R. E., David T. E. Spontaneous rupture of the liver caused by hepatomas. Surgery. 1973 Nov;74(5):715–719. [PubMed] [Google Scholar]
  7. Lai E. C., Choi T. K., Tong S. W., Ong G. B., Wong J. Treatment of unresectable hepatocellular carcinoma: results of a randomized controlled trial. World J Surg. 1986 Jun;10(3):501–509. doi: 10.1007/BF01655321. [DOI] [PubMed] [Google Scholar]
  8. Lee C. S., Sung J. L., Hwang L. Y., Sheu J. C., Chen D. S., Lin T. Y., Beasley R. P. Surgical treatment of 109 patients with symptomatic and asymptomatic hepatocellular carcinoma. Surgery. 1986 Apr;99(4):481–490. [PubMed] [Google Scholar]
  9. Lee N. W., Wong J., Ong G. B. The surgical management of primary carcinoma of the liver. World J Surg. 1982 Jan;6(1):66–75. doi: 10.1007/BF01656375. [DOI] [PubMed] [Google Scholar]
  10. Nagasue N., Yukaya H., Hamada T., Hirose S., Kanashima R., Inokuchi K. The natural history of hepatocellular carcinoma. A study of 100 untreated cases. Cancer. 1984 Oct 1;54(7):1461–1465. doi: 10.1002/1097-0142(19841001)54:7<1461::aid-cncr2820540740>3.0.co;2-7. [DOI] [PubMed] [Google Scholar]
  11. ONG G. B., CHU E. P., YU F. Y., LEE T. C. SPONTANEOUS RUPTURE OF HEPATOCELLULAR CARCINOMA. Br J Surg. 1965 Feb;52:123–129. doi: 10.1002/bjs.1800520210. [DOI] [PubMed] [Google Scholar]
  12. Ong G. B., Taw J. L. Spontaneous rupture of hepatocellular carcinoma. Br Med J. 1972 Oct 21;4(5833):146–149. doi: 10.1136/bmj.4.5833.146. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Pugh R. N., Murray-Lyon I. M., Dawson J. L., Pietroni M. C., Williams R. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg. 1973 Aug;60(8):646–649. doi: 10.1002/bjs.1800600817. [DOI] [PubMed] [Google Scholar]
  14. Tang Z. Y., Yu Y. Q., Zhou X. D., Chen Q. M. Factors influencing primary liver cancer resection survival rate. Chin Med J (Engl) 1981 Nov;94(11):749–754. [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES