Recurrence rate and overall survival of operated ruptured hepatocellular carcinomas.

OBJECTIVE: Hepatocellular carcinomas (HCC) can infrequently rupture and cause hemorrhage. Little is known on recurrence rate (RR) and overall survival (OS) in case of ruptured HCC. This study aimed to assess RR, time to recurrence, and OS of operated ruptured HCC.

PATIENTS AND METHODS: All operated patients with HCC (1999-2015) were reviewed. Patient demographics, perioperative details, and postoperative outcomes of ruptured HCC were recorded. RR, time to recurrence, and OS were calculated. RR and OS of ruptured and non-ruptured HCC were compared.

RESULTS: Among the 140 consecutive patients with HCC operated during the study period, 14 presented with rupture. Eleven patients had cirrhosis (all Child-Pugh A). At presentation, median α-fetoprotein and hemoglobin levels were 23 µg/l (interquartile range: 5-883) and 127 g/l (118-148), respectively. All but one patient felt abdominal pain, and two were in hemorrhagic shock. Preoperative embolization with staged hepatectomy was performed in seven patients. Five patients were first treated conservatively and then had an elective hepatectomy, whereas two patients had upfront surgery (one packing and one segmentectomy). Major hepatectomy was performed in eight cases. Median intraoperative blood loss was 1000 ml (500-2100). Overall complication rate was 36%. Eight patients presented a recurrence (57%; median time to recurrence: 8 months; interquartile range: 6-19). Median OS was 44 months, and 5-year OS was 41%. The 126 operated patients with non-ruptured HCC had a RR of 59/126 (47%; P=0.576) and a 5-year OS of 61% (P=0.448).

CONCLUSION: RR between ruptured and non-ruptured HCC were similar. Moreover, HCC rupture did not impair OS compared with HCC without rupture.