Clinical study on emergency hepatectomy and second stage hepatectomy after TACE in spontaneous rupture and bleeding of resectable primary liver caner_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LI Guanyin ,  PENG Yong , MA Hai , TIAN Yunhong

Department of Hepatobiliary Surgery, The Second Clinical of Sichuan North Medical College·Nanchong Central Hospital, Nanchong, Sichuan 637000, P. R. China;

Corresponding?author：

PENG Yong, Email: 13508081615@163.com

Keywords：

primary liver cancer; spontaneous rupture and bleeding; hepatectomy; transcatheter arterial chemoembolization

DOI：

10.7507/1007-9424.201906058

Video：

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Objective To investigate the effect and prognosis of emergency hepatectomy and second stage hepatectomy after transcatheter arterial chemoembolization (TACE) in spontaneous rupture and bleeding of resectable primary liver cancer.Methods A total of 42 patients with spontaneous rupture and bleeding of resectable primary liver cancer in this hospital from January 2010 to January 2016 were retrospectively reviewed. Among them 24 cases had accepted the emergency hepatectomy in 24 h–48 h after admission (emergency hepatectomy group, n=24), 18 cases had accepted the second stage hepatectomy in 1 week–2 weeks after the TACE (second stage hepatectomy group, n=18), the intraoperative blood loss and intraoperative blood transfusion volume, perioperative mortality, postoperative incidence of hepatic insufficiency, recurrence rate and abdominal metastasis rate within 1 year after the operation, 1- and 3-year survival rates were compared between the emergency hepatectomy group and the second stage hepatectomy group.Results There was no significant difference in the preoperative general data between these two groups (P>0.050). The intraoperative blood loss and transfusion volume of the emergency hepatectomy group were significantly more than those of the second stage hepatectomy group (P=0.028, P=0.017). There were no significant differences in the perioperative mortality (P=0.489), incidence of hepatic insufficiency (P=1.000), 1- and 3-year survival rates (P=0.650, P=0.463) and 1-year recurrence rate (P=0.601) between these two groups. No intraperitoneal implantation metastasis was found in these two groups.Conclusion Both emergency hepatectomy and second stage hepatectomy after TACE are safe and effective in treatment of spontaneous rupture and bleeding of resectable primary liver cancer, appropriate treatment should be selected according to the specific conditions of patients.

Citation： LI Guanyin, PENG Yong, MA Hai, TIAN Yunhong. Clinical study on emergency hepatectomy and second stage hepatectomy after TACE in spontaneous rupture and bleeding of resectable primary liver caner. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2020, 27(1): 48-52. doi: 10.7507/1007-9424.201906058 Copy

1.	Saxena A, Chua TC, Chu FC, et al. Improved outcomes after aggressive surgical resection of hilar cholangiocarcinoma: a critical analysis of recurrence and survival. Am J Surg, 2011, 202(3): 310-320.
2.	Han XJ, Su HY, Shao HB, et al. Prognostic factors of spontaneously ruptured hepatocellular carcinoma. World J Gastroenterol, 2015, 21(24): 7488-7494.
3.	劉孟鋒, 劉連新. 原發性肝癌自發性破裂出血的診療現狀. 醫學綜述, 2017, 23(16): 3193-3196, 3201.
4.	Miyoshi A, Kitahara K, Kohya N, et al. Outcomes of patients with spontaneous rupture of hepatocellular carcinoma. Hepatogastroenterology, 2011, 58(105): 99-102.
5.	歐迪鵬, 楊連粵, 楊浩, 等. 急診肝切除治療原發性肝癌破裂的預后分析. 中國普通外科雜志, 20l7, 26(1): 25-30.
6.	Ou D, Yang H, Zeng Z, et al. Comparison of the prognostic influence of emergency hepatectomy and staged hepatectomy in patients with ruptured hepatocellular carcinoma. Dig Liver Dis, 2016, 48(8): 934-939.
7.	Yoshida H, Mamada Y, Taniai N, et al. Spontaneous ruptured hepatocellular carcinoma. Hepatol Res, 2016, 46(1): 13-21.
8.	劉嘉林, 李軍, 鮑世韻, 等. 急診肝動脈栓塞治療原發性肝癌自發破裂出血(附38例報告). 中國普外基礎與臨床雜志, 2003, 10(3): 276-277.
9.	Hiraoka A, Kawamura T, Aibiki T, et al. Prognosis and therapy for ruptured hepatocellular carcinoma: problems with staging and treatment strategy. Eur J Radiol, 2015, 84(3): 366-371.
10.	Xia F, Lau WY, Qian C, et al. Continuous occlusion of hepatic artery proper for prevention of blood loss in partial hepatectomy for ruptured hepatocellular carcinoma: a case-matched comparative study. Ann Surg Oncol, 2011, 18(6): 1638-1643.
11.	Yim HJ, Suh SJ, Um SH. Current management of hepatocellular carcinoma: an Eastern perspective. World J Gastroenterol, 2015, 21(13): 3826-3842.
12.	Darnis B, Rode A, Mohkam K, et al. Management of bleeding liver tumors. J Visc Surg, 2014, 151(5): 365-375.
13.	劉發生, 吳成輝. 原發性肝癌自發性破裂腹腔內出血53例診治體會. 中國普外基礎與臨床雜志, 2008, 15(12): 933-934.
14.	朱立新, 耿小平, 范上達. 肝癌自發性破裂患者血管超微結構研究. 中華外科雜志, 2006, 44(3): 161-164.
15.	Minutolo V, Licciardello A, Arena M, et al. Surgical resection of ruptured fibrolamellar hepatocellular carcinoma. Case Rep Surg, 2013, 2013: 679565.
16.	錢相君, 賀濤, 萬百順, 等. 手術時機的選擇對原發性肝癌破裂出血術后預后生存的影響. 胃腸病學和肝病學雜志, 2017, 26(4): 407-411.
17.	Lai EC, Lau WY. Spontaneous rupture of hepatocellular carcinoma: a systematic review. Arch Surg, 2006, 141(2): 191-198.
18.	Tanaka S, Kaibori M, Ueno M, et al. Surgical outcomes for the ruptured hepatocellular carcinoma: multicenter analysis with a case-controlled study. J Gastrointest Surg, 2016, 20(12): 2021-2034.
19.	Yang T, Sun YF, Zhang J, et al. Partial hepatectomy for ruptured hepatocellular carcinoma. Br J Surg, 2013, 100(8): 1071-1079.
20.	Kirikoshi H, Saito S, Yoneda M, et al. Outcomes and factors influencing survival in cirrhotic cases with spontaneous rupture of hepatocellular carcinoma: a multicenter study. BMC Gastroenterol, 2009, 9: 29.
21.	Zhu Q, Li J, Yan JJ, et al. Predictors and clinical outcomes for spontaneous rupture of hepatocellular carcinoma. World J Gastroenterol, 2012, 18(48): 7302-7307.
22.	Yang H, Chen K, Wei Y, et al. Treatment of spontaneous ruptured hepatocellular carcinoma: A single-center study. Pak J Med Sci, 2014, 30(3): 472-476.
23.	王翔翔, 余華, 熊杰, 等. 肝動脈化療栓塞對原發性肝癌患者術后生存及復發的影響. 中國普外基礎與臨床雜志, 2012, 19(11): 1204-1207.
24.	Zhou SJ, Zhang EL, Liang BY, et al. Erratum to: distilled water lavage during surgery improves long-term outcomes of patients with ruptured hepatocellular carcinoma. J Gastrointest Surg, 2015, 19(9): 1737-1738.
25.	Chow KC, Tang CN, Lai EC, et al. Curative treatment for recurrent tumour implantation after ruptured hepatocellular carcinoma. Hong Kong Med J, 2013, 19(1): 82-84.

1. Saxena A, Chua TC, Chu FC, et al. Improved outcomes after aggressive surgical resection of hilar cholangiocarcinoma: a critical analysis of recurrence and survival. Am J Surg, 2011, 202(3): 310-320.
2. Han XJ, Su HY, Shao HB, et al. Prognostic factors of spontaneously ruptured hepatocellular carcinoma. World J Gastroenterol, 2015, 21(24): 7488-7494.
3. 劉孟鋒, 劉連新. 原發性肝癌自發性破裂出血的診療現狀. 醫學綜述, 2017, 23(16): 3193-3196, 3201.
4. Miyoshi A, Kitahara K, Kohya N, et al. Outcomes of patients with spontaneous rupture of hepatocellular carcinoma. Hepatogastroenterology, 2011, 58(105): 99-102.
5. 歐迪鵬, 楊連粵, 楊浩, 等. 急診肝切除治療原發性肝癌破裂的預后分析. 中國普通外科雜志, 20l7, 26(1): 25-30.
6. Ou D, Yang H, Zeng Z, et al. Comparison of the prognostic influence of emergency hepatectomy and staged hepatectomy in patients with ruptured hepatocellular carcinoma. Dig Liver Dis, 2016, 48(8): 934-939.
7. Yoshida H, Mamada Y, Taniai N, et al. Spontaneous ruptured hepatocellular carcinoma. Hepatol Res, 2016, 46(1): 13-21.
8. 劉嘉林, 李軍, 鮑世韻, 等. 急診肝動脈栓塞治療原發性肝癌自發破裂出血(附38例報告). 中國普外基礎與臨床雜志, 2003, 10(3): 276-277.
9. Hiraoka A, Kawamura T, Aibiki T, et al. Prognosis and therapy for ruptured hepatocellular carcinoma: problems with staging and treatment strategy. Eur J Radiol, 2015, 84(3): 366-371.
10. Xia F, Lau WY, Qian C, et al. Continuous occlusion of hepatic artery proper for prevention of blood loss in partial hepatectomy for ruptured hepatocellular carcinoma: a case-matched comparative study. Ann Surg Oncol, 2011, 18(6): 1638-1643.
11. Yim HJ, Suh SJ, Um SH. Current management of hepatocellular carcinoma: an Eastern perspective. World J Gastroenterol, 2015, 21(13): 3826-3842.
12. Darnis B, Rode A, Mohkam K, et al. Management of bleeding liver tumors. J Visc Surg, 2014, 151(5): 365-375.
13. 劉發生, 吳成輝. 原發性肝癌自發性破裂腹腔內出血53例診治體會. 中國普外基礎與臨床雜志, 2008, 15(12): 933-934.
14. 朱立新, 耿小平, 范上達. 肝癌自發性破裂患者血管超微結構研究. 中華外科雜志, 2006, 44(3): 161-164.
15. Minutolo V, Licciardello A, Arena M, et al. Surgical resection of ruptured fibrolamellar hepatocellular carcinoma. Case Rep Surg, 2013, 2013: 679565.
16. 錢相君, 賀濤, 萬百順, 等. 手術時機的選擇對原發性肝癌破裂出血術后預后生存的影響. 胃腸病學和肝病學雜志, 2017, 26(4): 407-411.
17. Lai EC, Lau WY. Spontaneous rupture of hepatocellular carcinoma: a systematic review. Arch Surg, 2006, 141(2): 191-198.
18. Tanaka S, Kaibori M, Ueno M, et al. Surgical outcomes for the ruptured hepatocellular carcinoma: multicenter analysis with a case-controlled study. J Gastrointest Surg, 2016, 20(12): 2021-2034.
19. Yang T, Sun YF, Zhang J, et al. Partial hepatectomy for ruptured hepatocellular carcinoma. Br J Surg, 2013, 100(8): 1071-1079.
20. Kirikoshi H, Saito S, Yoneda M, et al. Outcomes and factors influencing survival in cirrhotic cases with spontaneous rupture of hepatocellular carcinoma: a multicenter study. BMC Gastroenterol, 2009, 9: 29.
21. Zhu Q, Li J, Yan JJ, et al. Predictors and clinical outcomes for spontaneous rupture of hepatocellular carcinoma. World J Gastroenterol, 2012, 18(48): 7302-7307.
22. Yang H, Chen K, Wei Y, et al. Treatment of spontaneous ruptured hepatocellular carcinoma: A single-center study. Pak J Med Sci, 2014, 30(3): 472-476.
23. 王翔翔, 余華, 熊杰, 等. 肝動脈化療栓塞對原發性肝癌患者術后生存及復發的影響. 中國普外基礎與臨床雜志, 2012, 19(11): 1204-1207.
24. Zhou SJ, Zhang EL, Liang BY, et al. Erratum to: distilled water lavage during surgery improves long-term outcomes of patients with ruptured hepatocellular carcinoma. J Gastrointest Surg, 2015, 19(9): 1737-1738.
25. Chow KC, Tang CN, Lai EC, et al. Curative treatment for recurrent tumour implantation after ruptured hepatocellular carcinoma. Hong Kong Med J, 2013, 19(1): 82-84.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical study on emergency hepatectomy and second stage hepatectomy after TACE in spontaneous rupture and bleeding of resectable primary liver caner

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