Intraperitoneal hemorrhage from hepatocellular carcinoma: emergency chemoembolization or embolization

Area of Science:

• Hepatobiliary Malignancies
• Interventional Radiology
• Oncology

Background:

• Hepatocellular carcinoma (HCC) can present with life-threatening intraperitoneal hemorrhage.
• Emergency treatment options for HCC hemorrhage are critical for patient survival.
• Prognostic factors influencing outcomes in HCC patients with hemorrhage require further elucidation.

Purpose of the Study:

• To evaluate the efficacy of emergency embolization in patients with intraperitoneal hemorrhage secondary to HCC.
• To determine the correlation between pre-embolization serum bilirubin levels and patient prognosis.
• To assess the impact of portal vein tumor thrombus on outcomes following embolization.

Main Methods:

• Retrospective analysis of 38 patients with HCC-related intraperitoneal hemorrhage treated between 1982 and 1990.
• Patients were categorized into two groups based on pre-treatment serum total bilirubin levels: ≤3.0 mg/dL (Group A) and >3.0 mg/dL (Group B).
• Treatment involved emergency embolization, with or without adjuvant chemotherapy and iodized oil.

Main Results:

• Successful hemostasis was achieved in all 38 patients.
• Mean survival was significantly longer in Group A (165 days) compared to Group B (13 days) (P < .00003).
• While portal vein tumor thrombus was associated with poorer prognosis, it did not significantly impact survival differences between bilirubin groups (P = .145).

Conclusions:

• Emergency embolization is a safe and effective intervention for intraperitoneal hemorrhage in HCC patients.
• Pre-embolization serum bilirubin level is a critical independent predictor of survival in this patient cohort.
• Patients with lower serum bilirubin levels exhibit significantly better prognoses following emergency embolization for HCC hemorrhage.