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01-01-2018 | Original Scientific Report

Bleeding Recurrence and Mortality Following Interventional Management of Spontaneous HCC Rupture: Results of a Multicenter European Study

Authors: Lilian Schwarz, Michael Bubenheim, Johanna Zemour, Astrid Herrero, Fabrice Muscari, Ahmet Ayav, Romain Riboud, Christian Ducerf, J-Marc Regimbeau, Hadrien Tranchart, Emilie Lermite, Gheorghe Petrovai, Amal Suhol, Alexandre Doussot, Lorenzo Capussotti, Jean Jacques Tuech, Yves Patrice Le Treut, the FRENCH association

Published in: World Journal of Surgery | Issue 1/2018

Abstract

Background

The incidence of spontaneous rupture of hepatocellular carcinoma (HCC) is low in Europe, at less than 3%. HCC rupture remains a life-threatening complication, with mortality reported between 16 and 30%. The risk of bleeding recurrence has never been clearly evaluated in such clinical situation. The objectives of this study were to evaluate the current risk of mortality related to HCC rupture and to focus on the risk of bleeding recurrence following interventional management.

Methods

All patients admitted to 14 French–Italian surgical centers for spontaneous rupture of HCC between May 2000 and May 2012 were retrospectively included. Clinical data, imaging features, relevant laboratory data, treatment strategies, and prognoses were analyzed.

Results

Overall, 58 of the 138 included patients (42%) had cirrhosis. Thirty-five patients (25%) presented with hemorrhagic shock, and 19% with organ(s) dysfunction. Bleeding control was obtained by interventional hemostasis, emergency liver resection, and conservative medical management in 86 (62%), 24 (18%), and 21 (15%) patients, respectively. Best supportive care was chosen for 7 (5%) patients. The mortality rate following rupture was 24%. The bleeding recurrence rate was 22% with related mortality of 52%. In multivariate analysis, a bilirubin level >17 micromol/L (HR 3.768; p = 0.006), bleeding recurrence (HR 5.400; p < 0.0001), and ICU admission after initial management (HR 8.199; p < 0.0001) were associated with in-hospital mortality.

Conclusion

This European, multicenter, large-cohort study confirmed that the prognosis of ruptured HCC is poor with an overall mortality rate of 24%, despite important advances in endovascular techniques. Overall, the rate of bleeding recurrence was more than 20%, with a related high risk of mortality.

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Title: Bleeding Recurrence and Mortality Following Interventional Management of Spontaneous HCC Rupture: Results of a Multicenter European Study
Authors: Lilian Schwarz
Michael Bubenheim
Johanna Zemour
Astrid Herrero
Fabrice Muscari
Ahmet Ayav
Romain Riboud
Christian Ducerf
J-Marc Regimbeau
Hadrien Tranchart
Emilie Lermite
Gheorghe Petrovai
Amal Suhol
Alexandre Doussot
Lorenzo Capussotti
Jean Jacques Tuech
Yves Patrice Le Treut
the FRENCH association
Publication date: 01-01-2018
Publisher: Springer International Publishing
Published in: World Journal of Surgery / Issue 1/2018
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-017-4163-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Bleeding Recurrence and Mortality Following Interventional Management of Spontaneous HCC Rupture: Results of a Multicenter European Study

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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