Management of spontaneous rupture HCC in the post RFA era

Abstract

Objectives:To investigate the outcome and prognosis of spontaneous ruptured HCC by analysis of a cohort of 189 patients. Method:All patients who presented with ruptured HCC and required hospitalisation from 1991 to 2010 were recorded amongst the 5283 patients with the diagnosis of HCC. The patients were categorised into two 10-year periods. (Period 1 n=70), (Period 2 n= 119). Both groups were managed according to standard treatment protocol and RFA devices become available in the second period. Results:Both groups of patients were hepatitis B virus predominant. There was no different in terms of age, liver function, preoperative morbidities and stage of disease in the two groups of patients. In period 2 patients, the 30 days hospital mortality rate was 2.5% (3 out of 119) vs 14.2% (10 out of 70) in period 1 (p=0.011). In period 2 73.1% patients received RFA as a haemostasis modality. The one year survival in period 2 was 18.9% vs 18.8% in period 1 (p=0.348). After multivariate analysis by cox regression model haemostasis by RFA provided a favorable survival outome. Conclusions:RFA effectively reduced surgical mortality with this disease entity even in a population where hepatitis B related cirrhosis was common.