Related Experiment Videos
Spontaneous rupture of hepatocellular carcinoma: an approach with delayed hepatectomy
S Inoue1, T Nagao, T Wakabayashi
1Department of Organ Transplantation, University of Tokyo, Japan.
Insights
Ruptured hepatocellular carcinoma (HCC) in cirrhotic patients can be successfully managed with elective hepatectomy after initial conservative treatment. A "wait and see" approach may be effective for selected ruptured HCC cases.
Area of Science:
- Hepatobiliary Surgery
- Surgical Oncology
- Gastroenterology
Background:
- Hepatocellular carcinoma (HCC) is a common primary liver cancer.
- Ruptured HCC with hemoperitoneum presents a surgical emergency.
- Cirrhosis is a common underlying condition in HCC patients.
Observation:
- Two patients with ruptured HCC and hemoperitoneum due to hypovolemic shock were initially treated conservatively.
- Conservative management involved blood and plasma transfusions for over a month until liver function stabilized.
- Neither surgical hemostasis nor transcatheter hepatic arterial embolization was performed initially.
Findings:
- Elective hepatectomy was successfully performed in both patients.
- The use of a microwave tissue coagulator minimized intra-operative blood loss during hepatectomy.
- Both patients experienced excellent post-operative recovery.
Implications:
- A selective "wait and see" policy can be effective for managing ruptured HCC in cirrhotic patients.
- Minimally invasive techniques like microwave tissue coagulation improve surgical outcomes.
- This approach highlights the importance of careful patient selection and timing of surgical intervention.
Abstract:
Two cirrhotic patients with ruptured hepatocellular carcinoma (HCC), presenting with hemoperitoneum, were successfully treated by elective hepatectomy. Both of these patients, a 67-year-old female and a 76-year-old male, had first been taken to other primary hospitals by ambulance due to hypovolemic shock. They were then found to have a mass of approximately 5 cm in the cirrhotic liver. In the initial management, however, neither any direct hemostasis by surgery nor indirect measures such as transcatheter hepatic arterial embolization were performed in either case. Instead, conservative treatment consisting mainly of fresh blood and plasma transfusions were continued for more than a month until the liver function stabilized. In both hepatectomies, the use of a microwave tissue coagulator resulted in minimal intra-operative blood loss and an appreciably excellent post-operative course. These cases point to the effectiveness of a "wait and see" policy for selected patients with ruptured HCC.