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.	刘孟锋, 刘连新. 原发性肝癌自发性破裂出血的诊疗现状. 医学综述, 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.	欧迪鹏, 杨连粤, 杨浩, 等. 急诊肝切除治疗原发性肝癌破裂的预后分析. 中国普通外科杂志, 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.	刘嘉林, 李军, 鲍世韵, 等. 急诊肝动脉栓塞治疗原发性肝癌自发破裂出血(附38例报告). 中国普外基础与临床杂志, 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.	刘发生, 吴成辉. 原发性肝癌自发性破裂腹腔内出血53例诊治体会. 中国普外基础与临床杂志, 2008, 15(12): 933-934.
14.	朱立新, 耿小平, 范上达. 肝癌自发性破裂患者血管超微结构研究. 中华外科杂志, 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.	钱相君, 贺涛, 万百顺, 等. 手术时机的选择对原发性肝癌破裂出血术后预后生存的影响. 胃肠病学和肝病学杂志, 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, 余华, 熊杰, 等. 肝动脉化疗栓塞对原发性肝癌患者术后生存及复发的影响. 中国普外基础与临床杂志, 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. 刘孟锋, 刘连新. 原发性肝癌自发性破裂出血的诊疗现状. 医学综述, 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. 欧迪鹏, 杨连粤, 杨浩, 等. 急诊肝切除治疗原发性肝癌破裂的预后分析. 中国普通外科杂志, 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. 刘嘉林, 李军, 鲍世韵, 等. 急诊肝动脉栓塞治疗原发性肝癌自发破裂出血(附38例报告). 中国普外基础与临床杂志, 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. 刘发生, 吴成辉. 原发性肝癌自发性破裂腹腔内出血53例诊治体会. 中国普外基础与临床杂志, 2008, 15(12): 933-934.
14. 朱立新, 耿小平, 范上达. 肝癌自发性破裂患者血管超微结构研究. 中华外科杂志, 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. 钱相君, 贺涛, 万百顺, 等. 手术时机的选择对原发性肝癌破裂出血术后预后生存的影响. 胃肠病学和肝病学杂志, 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, 余华, 熊杰, 等. 肝动脉化疗栓塞对原发性肝癌患者术后生存及复发的影响. 中国普外基础与临床杂志, 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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