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FACTORS AFFECTING EARLY MORTALITY IN SPONTANEOUS RUPTURE OF HEPATOCELLULAR CARCINOMA
Author(s) -
Tan Felicia L.S.,
Tan YuMeng,
Chung Alexander Y.F.,
Cheow Peng C.,
Chow Pierce K.H.,
Ooi London L.
Publication year - 2006
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/j.1445-2197.2006.03750.x
Subject(s) - medicine , hepatocellular carcinoma , blood transfusion , cirrhosis , univariate analysis , mortality rate , hemoperitoneum , surgery , shock (circulatory) , multivariate analysis , retrospective cohort study
Background: Spontaneous rupture of hepatocellular carcinoma (HCC) is a catastrophic surgical emergency with high mortality rates. The aim of this study is to determine the factors associated with the prognosis and to assess the outcome of different management strategies. Methods: A retrospective study of 34 consecutive patients with spontaneous rupture of HCC was conducted from January 1996 to January 2004. Clinical, biochemical and operative factors influencing 30‐day mortality were analysed. Results: In our study, 30‐day mortality rate was 32% ( n = 11). Presence of cirrhosis, Child’s C status, shock on admission, higher blood transfusion requirement, raised α‐fetoprotein, raised alkaline phosphatase, raised aspartate transaminase, and raised indocyanine green at 15 min were all associated with increased risk of 30‐day mortality on univariate analysis ( P < 0.05). On multivariate analysis, only shock on admission ( P = 0.001) and higher blood transfusion requirement ( P = 0.01) were significant independent factors affecting early mortality. Surgical intervention was associated with a better 30‐day survival as compared with medical therapy or transarterial embolization. The median survival time of patients undergoing curative resection was significantly longer than that of patients who had surgery for haemostasis only (420 vs 205 days). The overall median survival was 161 days. Conclusions: Spontaneous rupture of HCC is a potentially salvageable complication of HCC. Poor prognosis is associated with poor liver reserve, advanced disease and severity of haemorrhage. Shock and blood transfusion requirement are the only independent factors affecting early mortality.