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J Gastrointest Surg. 2016 Dec;20(12):2021-2034. Epub 2016 Oct 7.

Surgical Outcomes for the Ruptured Hepatocellular Carcinoma: Multicenter Analysis with a Case-Controlled Study.

Author information

1
Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abenoku, Osaka, 545-8585, Japan. m8827074@msic.med.osaka-cu.ac.jp.
2
Department of Surgery, Hirakata Hospital, Kansai Medical University, Hirakata, Osaka, Japan.
3
Second Department of Surgery, Wakayama Medical University, Wakayama, Japan.
4
Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan.
5
Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Osaka, Japan.
6
Department of Surgery, Faculty of Medicine, Kinki University, Osaka-Sayama, Osaka, Japan.
7
Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abenoku, Osaka, 545-8585, Japan.

Abstract

BACKGROUND:

While spontaneously ruptured hepatocellular carcinoma (HCC) has a poor prognosis, the true impact of a rupture on survival after hepatic resection is unclear.

METHODS:

Fifty-eight patients with ruptured HCC and 1922 with non-ruptured HCC underwent hepatic resection between 2000 and 2013. To correct the difference in the clinicopathological factors between the two groups, propensity score matching (PSM) was used at a 1:1 ratio, resulting in a comparison of 42 patients/group. We investigated outcomes in all patients with ruptured HCC and compared outcomes between the two matched groups.

RESULTS:

Of the 58 patients with ruptured HCC, 7 patients (13 %) died postoperatively. Overall survival (OS) rate at 5 years after hepatic resection was 37 %. Emergency hepatic resection was an independent risk factor for in-hospital death and Child-Pugh class B for unfavorable OS in multivariate analysis. Clinicopathological variables were well-balanced between the two groups after PSM. No significant differences were noted in incidence of in-hospital death (ruptured HCC 12 % vs non-ruptured HCC 2 %, p = 0.202) or OS rate (5/10-year; 42 %/38 % vs 67 %/30 %, p = 0.115).

CONCLUSION:

Emergency hepatic resection should be avoided for ruptured HCC in Child-Pugh class B patients. Rupture itself was not a risk for unfavorable surgical outcomes.

KEYWORDS:

Child-Pugh class B; Extrahepatic recurrence; Milan criteria

PMID:
27718151
DOI:
10.1007/s11605-016-3280-2
[Indexed for MEDLINE]

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