International Journal of Gastroenterology

| Peer-Reviewed |

Ruptured Hepatocellular Carcinoma-Experience in a Tertiary Centre in Western Australia

Received: Sep. 15, 2018    Accepted: Oct. 08, 2018    Published: Nov. 07, 2018
Views:       Downloads:

Share This Article

Abstract

Hepatocellular carcinoma (HCC) is a leading cause of cancer-related deaths worldwide. Spontaneous tumour rupture (STR) is uncommon, with incidence rates around 10-15% in Asia, but below 3% in Western countries. Nonetheless, serious complications lead to high mortality rates. To our knowledge, experience of HCC rupture has not been published in Australia. We identified 9 retrospective cases of ruptured HCC from 2008 to 2017 through patient case notes, electronic laboratory system, and imaging reports. Our case series presents 8 male and 1 female patient with a mean age of 56 years, and a median 11 month follow-up period. Sixty-six percent of patients were non-cirrhotic, and 33% cirrhotic, with a median post- tumour rupture survival rate of 10 months and 12 months, respectively. Seventy-eight percent of patients presented with abdominal pain and a mean tumour size of 8cm at time of rupture. Initial management involved: trans-arterial chemoembolisation (TACE)/ trans-arterial embolisation (TAE) in 4 patients, emergency hepatic resection in 3 patients, sorafenib in 1 patient and conservative/ supportive treatment in 1 patient. Reasons for our low HCC rupture incidence at 0.3% could be due to: none of our patients experiencing rebleeding (one of the common causes of mortality); strict surveillance programmes in Australia identifying early tumours; and majority of our patients being younger and non-cirrhotic with a better underlying liver reserve at time of rupture, and therefore improved outcomes.

DOI 10.11648/j.ijg.20180201.14
Published in International Journal of Gastroenterology ( Volume 2, Issue 1, June 2018 )
Page(s) 18-23
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Ruptured Hepatocellular Carcinoma, Trans-Arterial Chemoembolisation, Trans-Arterial Embolisation

References
[1] Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015 Mar 1; 136 (5):E359-86. doi: 10.1002/ijc.29210. PubMed PMID: 25220842.
[2] Fattovich G, Stroffolini T, Zagni I, et al. Hepatocellular carcinoma in cirrhosis: incidence and risk factors. Gastroenterology. 2004 Nov; 127 (5 Suppl 1):S35-50. PubMed PMID: 15508101.
[3] Yoshida H, Mamada Y, Taniai N, et al. Spontaneous ruptured hepatocellular carcinoma. Hepatol Res. 2016 Jan; 46 (1):13-21. doi: 10.1111/hepr.12498. PubMed PMID: 25631290.
[4] Lai EC, Lau WY. Spontaneous rupture of hepatocellular carcinoma: a systematic review. Arch Surg. 2006 Feb; 141 (2):191-8. doi: 10.1001/archsurg.141.2.191. PubMed PMID: 16490898.
[5] Liu CL, Fan ST, Lo CM, et al. Management of spontaneous rupture of hepatocellular carcinoma: single-center experience. J Clin Oncol. 2001 Sep 1; 19 (17):3725-32. doi: 10.1200/JCO.2001.19.17.3725. PubMed PMID: 11533094.
[6] Schwarz L, Bubenheim M, Zemour J, et al. Bleeding Recurrence and Mortality Following Interventional Management of Spontaneous HCC Rupture: Results of a Multicenter European Study. World J Surg. 2018 Jan; 42 (1):225-232. doi: 10.1007/s00268-017-4163-8. PubMed PMID: 28799103.
[7] Battula N, Madanur M, Priest O, et al. Spontaneous rupture of hepatocellular carcinoma: a Western experience. Am J Surg. 2009 Feb; 197 (2):164-7. doi: 10.1016/j.amjsurg.2007.10.016. PubMed PMID: 18926518.
[8] Hari DM, Leung AM, Lee JH, et al. AJCC Cancer Staging Manual 7th edition criteria for colon cancer: do the complex modifications improve prognostic assessment? J Am Coll Surg. 2013 Aug; 217 (2):181-90. doi: 10.1016/j.jamcollsurg.2013.04.018. PubMed PMID: 23768788; PubMed Central PMCID: PMCPMC4657944.
[9] Heimbach JK, Kulik LM, Finn RS, et al. AASLD guidelines for the treatment of hepatocellular carcinoma. Hepatology. 2018 Jan; 67 (1):358-380. doi: 10.1002/hep.29086. PubMed PMID: 28130846.
[10] Zhu Q, Li J, Yan JJ, et al. Predictors and clinical outcomes for spontaneous rupture of hepatocellular carcinoma. World J Gastroenterol. 2012 Dec 28; 18 (48):7302-7. doi: 10.3748/wjg.v18.i48.7302. PubMed PMID: 23326137; PubMed Central PMCID: PMCPMC3544034.
[11] Zhu LX, Geng XP, Fan ST. Spontaneous rupture of hepatocellular carcinoma and vascular injury. Arch Surg. 2001 Jun; 136 (6):682-7. PubMed PMID: 11387009.
[12] Zhu LX, Wang GS, Fan ST. Spontaneous rupture of hepatocellular carcinoma. Br J Surg. 1996 May; 83 (5):602-7. PubMed PMID: 8689200.
[13] Ong GB, Taw JL. Spontaneous rupture of hepatocellular carcinoma. Br Med J. 1972 Oct 21; 4 (5833):146-9. PubMed PMID: 4342761; PubMed Central PMCID: PMCPMC1786419.
[14] Chearanai O, Plengvanit U, Asavanich C, et al. Spontaneous rupture of primary hepatoma: report of 63 cases with particular reference to the pathogenesis and rationale treatment by hepatic artery ligation. Cancer. 1983 Apr 15; 51 (8):1532-6. PubMed PMID: 6297703.
[15] Vergara V, Muratore A, Bouzari H, et al. Spontaneous rupture of hepatocelluar carcinoma: surgical resection and long-term survival. Eur J Surg Oncol. 2000 Dec; 26 (8):770-2. doi: 10.1053/ejso.2000.1001. PubMed PMID: 11087643.
[16] Choi BG, Park SH, Byun JY, et al. The findings of ruptured hepatocellular carcinoma on helical CT. Br J Radiol. 2001 Feb; 74 (878):142-6. doi: 10.1259/bjr.74.878.740142. PubMed PMID: 11718385.
[17] Rijckborst V, Ter Borg MJ, Tjwa ET, et al. Short article: Management of ruptured hepatocellular carcinoma in a European tertiary care center. Eur J Gastroenterol Hepatol. 2016 Aug; 28 (8):963-6. doi: 10.1097/MEG.0000000000000652. PubMed PMID: 27116657.
[18] Tarantino L, Sordelli I, Calise F, et al. Prognosis of patients with spontaneous rupture of hepatocellular carcinoma in cirrhosis. Updates Surg. 2011 Mar; 63 (1):25-30. doi: 10.1007/s13304-010-0041-8. PubMed PMID: 21258886.
[19] Buczkowski AK, Kim PT, Ho SG, et al. Multidisciplinary management of ruptured hepatocellular carcinoma. J Gastrointest Surg. 2006 Mar; 10 (3):379-86. doi: 10.1016/j.gassur.2005.10.012. PubMed PMID: 16504883.
[20] Recordare A, Bonariol L, Caratozzolo E, et al. Management of spontaneous bleeding due to hepatocellular carcinoma. Minerva Chir. 2002 Jun; 57 (3):347-56. PubMed PMID: 12029230.
[21] Castells L, Moreiras M, Quiroga S, et al. Hemoperitoneum as a first manifestation of hepatocellular carcinoma in western patients with liver cirrhosis: effectiveness of emergency treatment with transcatheter arterial embolization. Dig Dis Sci. 2001 Mar; 46 (3):555-62. PubMed PMID: 11318532.
[22] Vivarelli M, Cavallari A, Bellusci R, et al. Ruptured hepatocellular carcinoma: an important cause of spontaneous haemoperitoneum in Italy. Eur J Surg. 1995 Dec; 161 (12):881-6. PubMed PMID: 8775629.
[23] Cherqui D, Panis Y, Rotman N, et al. Emergency liver resection for spontaneous rupture of hepatocellular carcinoma complicating cirrhosis. Br J Surg. 1993 Jun; 80 (6):747-9. PubMed PMID: 8392424.
[24] Bassi N, Caratozzolo E, Bonariol L, et al. Management of ruptured hepatocellular carcinoma: implications for therapy. World J Gastroenterol. 2010 Mar 14; 16 (10):1221-5. PubMed PMID: 20222165; PubMed Central PMCID: PMCPMC2839174.
[25] Kung CT, Liu BM, Ng SH, et al. Transcatheter arterial embolization in the emergency department for hemodynamic instability due to ruptured hepatocellular carcinoma: analysis of 167 cases. AJR Am J Roentgenol. 2008 Dec; 191 (6):W231-9. doi: 10.2214/AJR.07.3983. PubMed PMID: 19020209.
[26] Li WH, Cheuk EC, Kowk PC, et al. Survival after transarterial embolization for spontaneous ruptured hepatocellular carcinoma. J Hepatobiliary Pancreat Surg. 2009; 16 (4):508-12. doi: 10.1007/s00534-009-0094-6. PubMed PMID: 19381430.
[27] Moris D, Chakedis J, Sun SH, et al. Management, outcomes, and prognostic factors of ruptured hepatocellular carcinoma: A systematic review. J Surg Oncol. 2017 Nov 8. doi: 10.1002/jso.24869. PubMed PMID: 29116644.
[28] Llovet JM, Zucman-Rossi J, Pikarsky E, et al. Hepatocellular carcinoma. Nat Rev Dis Primers. 2016 Apr 14; 2:16018. doi: 10.1038/nrdp.2016.18. PubMed PMID: 27158749.
Cite This Article
  • APA Style

    Sarah Ng, Justin Chin, Sudhakar Rao, Nick Kontorinis, James Anderson, et al. (2018). Ruptured Hepatocellular Carcinoma-Experience in a Tertiary Centre in Western Australia. International Journal of Gastroenterology, 2(1), 18-23. https://doi.org/10.11648/j.ijg.20180201.14

    Copy | Download

    ACS Style

    Sarah Ng; Justin Chin; Sudhakar Rao; Nick Kontorinis; James Anderson, et al. Ruptured Hepatocellular Carcinoma-Experience in a Tertiary Centre in Western Australia. Int. J. Gastroenterol. 2018, 2(1), 18-23. doi: 10.11648/j.ijg.20180201.14

    Copy | Download

    AMA Style

    Sarah Ng, Justin Chin, Sudhakar Rao, Nick Kontorinis, James Anderson, et al. Ruptured Hepatocellular Carcinoma-Experience in a Tertiary Centre in Western Australia. Int J Gastroenterol. 2018;2(1):18-23. doi: 10.11648/j.ijg.20180201.14

    Copy | Download

  • @article{10.11648/j.ijg.20180201.14,
      author = {Sarah Ng and Justin Chin and Sudhakar Rao and Nick Kontorinis and James Anderson and Suresh Navadgi and Jee Kong and Adam Doyle and Wendy Cheng},
      title = {Ruptured Hepatocellular Carcinoma-Experience in a Tertiary Centre in Western Australia},
      journal = {International Journal of Gastroenterology},
      volume = {2},
      number = {1},
      pages = {18-23},
      doi = {10.11648/j.ijg.20180201.14},
      url = {https://doi.org/10.11648/j.ijg.20180201.14},
      eprint = {https://download.sciencepg.com/pdf/10.11648.j.ijg.20180201.14},
      abstract = {Hepatocellular carcinoma (HCC) is a leading cause of cancer-related deaths worldwide. Spontaneous tumour rupture (STR) is uncommon, with incidence rates around 10-15% in Asia, but below 3% in Western countries. Nonetheless, serious complications lead to high mortality rates. To our knowledge, experience of HCC rupture has not been published in Australia. We identified 9 retrospective cases of ruptured HCC from 2008 to 2017 through patient case notes, electronic laboratory system, and imaging reports. Our case series presents 8 male and 1 female patient with a mean age of 56 years, and a median 11 month follow-up period. Sixty-six percent of patients were non-cirrhotic, and 33% cirrhotic, with a median post- tumour rupture survival rate of 10 months and 12 months, respectively. Seventy-eight percent of patients presented with abdominal pain and a mean tumour size of 8cm at time of rupture. Initial management involved: trans-arterial chemoembolisation (TACE)/ trans-arterial embolisation (TAE) in 4 patients, emergency hepatic resection in 3 patients, sorafenib in 1 patient and conservative/ supportive treatment in 1 patient. Reasons for our low HCC rupture incidence at 0.3% could be due to: none of our patients experiencing rebleeding (one of the common causes of mortality); strict surveillance programmes in Australia identifying early tumours; and majority of our patients being younger and non-cirrhotic with a better underlying liver reserve at time of rupture, and therefore improved outcomes.},
     year = {2018}
    }
    

    Copy | Download

  • TY  - JOUR
    T1  - Ruptured Hepatocellular Carcinoma-Experience in a Tertiary Centre in Western Australia
    AU  - Sarah Ng
    AU  - Justin Chin
    AU  - Sudhakar Rao
    AU  - Nick Kontorinis
    AU  - James Anderson
    AU  - Suresh Navadgi
    AU  - Jee Kong
    AU  - Adam Doyle
    AU  - Wendy Cheng
    Y1  - 2018/11/07
    PY  - 2018
    N1  - https://doi.org/10.11648/j.ijg.20180201.14
    DO  - 10.11648/j.ijg.20180201.14
    T2  - International Journal of Gastroenterology
    JF  - International Journal of Gastroenterology
    JO  - International Journal of Gastroenterology
    SP  - 18
    EP  - 23
    PB  - Science Publishing Group
    SN  - 2640-169X
    UR  - https://doi.org/10.11648/j.ijg.20180201.14
    AB  - Hepatocellular carcinoma (HCC) is a leading cause of cancer-related deaths worldwide. Spontaneous tumour rupture (STR) is uncommon, with incidence rates around 10-15% in Asia, but below 3% in Western countries. Nonetheless, serious complications lead to high mortality rates. To our knowledge, experience of HCC rupture has not been published in Australia. We identified 9 retrospective cases of ruptured HCC from 2008 to 2017 through patient case notes, electronic laboratory system, and imaging reports. Our case series presents 8 male and 1 female patient with a mean age of 56 years, and a median 11 month follow-up period. Sixty-six percent of patients were non-cirrhotic, and 33% cirrhotic, with a median post- tumour rupture survival rate of 10 months and 12 months, respectively. Seventy-eight percent of patients presented with abdominal pain and a mean tumour size of 8cm at time of rupture. Initial management involved: trans-arterial chemoembolisation (TACE)/ trans-arterial embolisation (TAE) in 4 patients, emergency hepatic resection in 3 patients, sorafenib in 1 patient and conservative/ supportive treatment in 1 patient. Reasons for our low HCC rupture incidence at 0.3% could be due to: none of our patients experiencing rebleeding (one of the common causes of mortality); strict surveillance programmes in Australia identifying early tumours; and majority of our patients being younger and non-cirrhotic with a better underlying liver reserve at time of rupture, and therefore improved outcomes.
    VL  - 2
    IS  - 1
    ER  - 

    Copy | Download

Author Information
  • Department of Gastroenterology & Hepatology, Royal Perth Hospital, Perth, Australia

  • Department of Gastroenterology & Hepatology, Royal Perth Hospital, Perth, Australia

  • Department of General Surgery, Royal Perth Hospital, Perth, Australia

  • Department of Gastroenterology & Hepatology, Royal Perth Hospital, Perth, Australia

  • Department of Radiology, Royal Perth Hospital, Perth, Australia

  • Department of General Surgery, Royal Perth Hospital, Perth, Australia

  • Department of Gastroenterology & Hepatology, Royal Perth Hospital, Perth, Australia

  • Department of Gastroenterology & Hepatology, Royal Perth Hospital, Perth, Australia

  • Department of Gastroenterology & Hepatology, Royal Perth Hospital, Perth, Australia; School of Medicine and Health Services, Edith Cowan University, Perth, Australia; Department of Medicine, University of Western Australia, Perth, Australia

  • Section