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Published on: September 30, 2021
Factors affecting early mortality in spontaneous rupture of hepatocellular carcinoma
Felicia L-S Tan1, Yu-Meng Tan, Alexander Y-F Chung
1Hepatopancreaticobiliary Unit, Department of General Surgery, Singapore General Hospital, Singapore.
Insights
Spontaneous rupture of hepatocellular carcinoma (HCC) is a serious emergency. Shock and high blood transfusion needs independently predict early mortality, but surgical intervention improves survival.
Area of Science:
- Hepatobiliary surgery
- Surgical oncology
- Gastroenterology
Background:
- Spontaneous rupture of hepatocellular carcinoma (HCC) presents a critical surgical emergency with substantial mortality risks.
- Identifying prognostic factors and evaluating management strategies are crucial for improving patient outcomes.
Purpose of the Study:
- To determine factors influencing prognosis in spontaneous rupture of HCC.
- To assess the outcomes of various management strategies for this condition.
Main Methods:
- A retrospective analysis of 34 patients with spontaneous rupture of HCC between January 1996 and January 2004.
- Evaluation of clinical, biochemical, and operative factors to identify predictors of 30-day mortality.
Main Results:
- The 30-day mortality rate was 32%.
- Univariate analysis identified cirrhosis, Child's C status, shock on admission, high blood transfusion requirement, and elevated liver enzymes as risk factors.
- Multivariate analysis revealed shock on admission and higher blood transfusion requirements as independent predictors of early mortality.
- Surgical intervention demonstrated superior 30-day survival compared to medical management or transarterial embolization.
Conclusions:
- Spontaneous rupture of HCC is a potentially survivable complication.
- Prognosis is linked to liver reserve, disease stage, and hemorrhage severity.
- Shock and blood transfusion requirements are the sole independent predictors of early mortality.
Background:
Spontaneous rupture of hepatocellular carcinoma (HCC) is a catastrophic surgical emergency with high mortality rates. The aim of this study is to determine the factors associated with the prognosis and to assess the outcome of different management strategies.
Methods:
A retrospective study of 34 consecutive patients with spontaneous rupture of HCC was conducted from January 1996 to January 2004. Clinical, biochemical and operative factors influencing 30-day mortality were analysed.
Results:
In our study, 30-day mortality rate was 32% (n = 11). Presence of cirrhosis, Child's C status, shock on admission, higher blood transfusion requirement, raised alpha-fetoprotein, raised alkaline phosphatase, raised aspartate transaminase, and raised indocyanine green at 15 min were all associated with increased risk of 30-day mortality on univariate analysis (P < 0.05). On multivariate analysis, only shock on admission (P = 0.001) and higher blood transfusion requirement (P = 0.01) were significant independent factors affecting early mortality. Surgical intervention was associated with a better 30-day survival as compared with medical therapy or transarterial embolization. The median survival time of patients undergoing curative resection was significantly longer than that of patients who had surgery for haemostasis only (420 vs 205 days). The overall median survival was 161 days.
Conclusions:
Spontaneous rupture of HCC is a potentially salvageable complication of HCC. Poor prognosis is associated with poor liver reserve, advanced disease and severity of haemorrhage. Shock and blood transfusion requirement are the only independent factors affecting early mortality.
