Goals and background Spontaneous rupture is a rare complication of hepatocellular carcinoma (HCC). Treatment options consist of transcatheter arterial embolization (TAE), hepatic resection, and conservative therapy. The best approach is under debate. Study This study presents a review of clinical data of patients with a ruptured HCC admitted to a European tertiary care center. Results Eleven patients were included; six (55%) had underlying cirrhosis. The majority of patients (73%) had no previous history of HCC. Spontaneous HCC rupture was diagnosed using abdominal computed tomography with or without a diagnostic paracentesis. Computed tomography showed one or two tumors in eight (73%) patients; the other patients had multiple tumors or diffuse infiltrative HCC. Seven (64%) patients were initially treated by TAE and one (9%) patient underwent hepatic resection. The remaining three (27%) patients, all of whom had liver cirrhosis, received conservative therapy. Two patients initially treated by TAE underwent a delayed resection and ultimately received systemic therapy. Overall, at the end of the follow-up period, three patients were still alive at 84, 991, and 1026 days after the initial presentation. Eight (73%) patients had died after a median of 88 days (range 7-417). One year after presentation, none of the conservatively treated patients was alive compared with three out of seven (43%) patients treated with TAE with or without delayed resection. Conclusion Patients with a spontaneously ruptured HCC have a poor prognosis. In selected patients, however, prolonged survival is possible using TAE as initial therapy with or without a delayed resection and systemic therapy.

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doi.org/10.1097/MEG.0000000000000652, hdl.handle.net/1765/96144
European Journal of Gastroenterology and Hepatology
Department of Gastroenterology & Hepatology

Rijckborst, V., ter Borg, M., Tjwa, E., Sprengers, D., Verhoef, K. (Kees), Moelker, A. (Adriaan), … de Man, R. (2016). Management of ruptured hepatocellular carcinoma in a European tertiary care center. European Journal of Gastroenterology and Hepatology, 28(8), 963–966. doi:10.1097/MEG.0000000000000652