Hepatocellular carcinoma is still on the rise worldwide and has become the second leading cause of cancer-related death in China.
Screening for people at high risk for liver cancer is not yet available in China, and many patients with liver cancer have lost the opportunity for surgical treatment by the time they are seen, and about 3% to 15% of them are seen only because of spontaneous rupture and bleeding. This is the most common type of liver cancer, and the rate of death is significantly higher than that of ordinary liver cancer patients.
Case share: He didn’t know “hepatitis B needs to be controlled by medicine” for the first time until hepatocellular carcinoma ruptured and bleeding >
Management plan for ruptured hepatocellular carcinoma bleeding
After ruptured hepatocellular carcinoma bleeding occurs, the physician will evaluate the patient’s vital signs, systemic hemodynamic stability, tumor size, number, liver function status, and other factors before choosing the clinical management plan.
The options for clinical management based on a comprehensive assessment of the patient’s condition include emergency management and elective management.
- Emergency management includes conservative treatment, emergency hepatic artery embolization, and emergency surgical treatment (including hepatectomy and non-hepatectomy surgical treatment);
- Elective management includes conservative treatment, emergency hepatic artery embolization, and emergency surgical treatment.
- Elective management options include conservative treatment, elective hepatic artery chemoembolization, elective hepatic resection, and elective radiofrequency ablation.
Hepatectomy is an important treatment for ruptured hepatocellular carcinoma bleeding
Hepatectomy is the main treatment for ruptured hepatocellular carcinoma bleeding, which can achieve effective hemostasis and eradication of the tumor. Depending on the patient’s vital signs, hemodynamic status, liver function assessment, clotting time, tumor size and number, and presence of metastases, either emergency or elective hepatectomy can be performed.
The amount of intraoperative bleeding in patients was significantly associated with the occurrence of postoperative complications, in-hospital mortality, and long-term postoperative prognosis. Intraoperative application of the Pringle method with continuous arterial blockade significantly reduced intraoperative bleeding during ruptured hepatectomy without increasing the incidence of complications or impairment of liver function.
Ruptured hepatocellular carcinoma bleeding: emergency or elective hepatectomy?
There is still some debate about the choice of emergency or elective hepatectomy.
Emergency hepatectomy is associated with higher surgical risks and higher perioperative mortality in patients because of poorer liver function, reduced compensatory capacity of the liver, and poorer coagulation at the time of ruptured hepatocellular carcinoma bleeding.
Elective hepatectomy is usually performed 1 to 3 months after ruptured hepatocellular carcinoma bleeds. Patients who undergo elective hepatectomy have a lower perioperative mortality rate and a better long-term postoperative prognosis.
Other studies have shown no significant difference in the long-term postoperative prognosis between emergency and elective hepatectomy for ruptured hepatocellular carcinoma. Evidence from relevant randomized controlled studies is still lacking.
What are the surgical treatment options for non-hepatic resection?
Surgical treatments for non-hepatectomy include simple sutures, hemostatic gauze or other hemostatic material to stop bleeding, and hepatic artery ligation.
This surgical approach provides emergency control of further bleeding, but often has a poor prognosis and is prone to postoperative complications such as infection, liver failure, and tumor implantation and metastasis.
Thus, this procedure is only suitable for patients with hepatocellular carcinoma who are not eligible for hepatectomy, who are in poor general condition and cannot tolerate hepatectomy, or who have end-stage liver disease combined with progressive hepatocellular carcinoma that cannot be radically resected.