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1999 Abstract: 3480 DETERMINANTS OF SURVIVAL IN PATIENTS WITH SPONTANEOUS RUPTURE OF HEPATOCELLULAR CARCINOMA

Abstracts
1999 Digestive Disease Week

# 3480 DETERMINANTS OF SURVIVAL IN PATIENTS WITH SPONTANEOUS RUPTURE OF HEPATOCELLULAR CARCINOMA
Chi Leung Liu, C M Lo, S T Fan, Univ of Hong Kong Med Ctr, Queen Mary Hosp

A retrospective study was performed to determine the factors affecting the immediate survival outcome and long-term survival on patients presented with spontaneous rupture of hepatocellular carcinoma (HCC) during a nine-year period. Among the 1,493 patients with HCC presented to us from 1989 to 1997, 139 (9.3%) presented with spontaneous rupture of the tumor. Two-stage therapeutic approach was adopted in the management of these patients and consisted of initial management by conservative method, hemostasis by transarterial embolization (TAE) or surgical means followed by second-stage hepatic resection or transarterial oily chemoembolization (TOCE). Initial intervention to control bleeding included TAE in 37 patients, surgical hemostasis in 34 patients, among whom 23 underwent ligation of either ipsilateral or common hepatic artery, and conservative management only in 50 patients. The 30-day mortality rate of these 139 patients was 40%, and the major cause of death was liver failure. On multivariate analysis, the independent factors on presentation affecting the 30-day mortality rate were (1) hemoglobin; (2) albumin; (3) total bilirubin; (4) prothrombin time; (5) known diagnosis of inoperable tumor. Early mortality was not affected by the modality of initial treatment. After initial stabilization and clinical evaluation, 32 patients were considered suitable for hepatic resection, amongst whom 23 (72%) underwent major hepatic resection. The median survival of these 32 patients was 17 months and was significantly better than that of the 24 patients with unresectable disease received TOCE (7.7 months), but was significantly worse than that of the 296 patients undergone hepatic resection during the same study period without history of rupture (42 months) (P = 0.038). On multivariate analysis, the independent factors affecting the long-term survival were (1) albumin and (2) total bilirubin level; (3) known diagnosis of inoperable tumor; and (4) curative hepatic resection. In summary, the survival of patients presented with spontaneous rupture of HCC was determined by the pre-rupture disease state, the liver function when rupture and the severity of hemorrhage from rupture and was not dependent on the modality of immediate treatment. Second-stage hepatic resection was associated with best survival outcome.

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