Treatment Of Spontaneous Rupture Of Primary Liver Cancer

Background:Primary Liver Cancer (PHC) is one of the most common primary liver tumor and one of the most common cause of cancer-related death worldwide. And spontaneous rupture of Primary Liver Cancer (PHC) is a life-threatening presentation, with an incidence of<3% of PHC patients in Western countries, but an incidence of4.8% to 25.7% in our country.Objective:The aim of this study was to determine the factors influencing prognosis in cases of spontaneous ruptured PHC,to found Which factors are associated with an increased risk for rupture of PHC and to compare with surgical treatment in patients with no-ruptured PHC.Methods:A retrospective review was conducted on 47 cases of spontaneously ruptured PHC which were pathologically diagnosed from November 2002 to July 2009 in 2nd Xiangya Hospital of CSU, with respect to the clinical presentation, lab and imaging examinations, and pathological examination.47 cases with no-ruptured PHC were randomly selected as the control group. Statistical methods include Chi-square test, two-samples t-test, univariate analysis and Kaplan-Meier survival estimates with log-rank test.Results:1. Open surgical method was the mainstay of treatment for hemostasis various surgical procedures, including perihepatic packing, suture plication of bleeding tumors (5/47), hepatic artery ligation (HAL) (1/47), and liver resection (40/47) were reported to be effective in hemostasis. Open surgical procedures achieve a high rate of hemostasis but are associated with a high in-hospital mortality rate (4/47).2.The postoperative complications rate was 36.17% in ruptured group, while 23.40% in the nonruptured group, P=0.017.3. Hepatitis B virus infection(P=0.017), liver cirrhosis(P=0.000), Hepatocellular Carcinoma(P=0.017) relate to the ruptured PHC,and there were no significant differences between patients with ruptured HCC and nonruptured HCC in terms of AFP,tumor size, site, number, and portal vein invasion.4. It identified various factors, including a high Child-Pugh score and tumor size as significantly influencing the survival rate in patients with ruptured PHC.5. The in hospital mortality rate is 8.52% in ruptured group,2.13% and in nonruptured group P=0.609,;6. Patients with spontaneously ruptured PHC Survival analysis showed 1,3,5 year survival rate were42.6%,14.9% and 6.4% respectively with 16.04±3.03median survival time. Patients without spontaneously ruptured PHC were76.5%,46.8%,22.8%and10.6% respectively with 17.53±3.04median survival time. Patients with nonruptured PHC had a similar overall survival as those with ruptured HCC.Conclusions:1. Spontaneous rupture of PHC is a fatal complication of advanced PHC. Due to the low incidence and nonspecific presentation, diagnosis of Spontaneous rupture of PHC is hard to be established on early stage and preoperative stage. Surgical resection is the optimal therapeutic approach showing good outcome, contributed by the tumor biological characteristics, such as good liver preservation.2. Liver cirrhosis, Hepatocellular Carcinoma may be relate to the ruptured PHC.3. It identified various factors, including a high Child-Pugh score, and the size of the tumor are important prognostic factors to predict survival after operation.4. The long-term outcome of liver resection is the same for Primary Liver Cancer with and without rupture when patients with the same tumor stage and liver functional state.