Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 14, 2015; 21(26): 8163-8169
Published online Jul 14, 2015. doi: 10.3748/wjg.v21.i26.8163
Management of hepatocellular carcinoma rupture in the caudate lobe
De-Fei Hong, Ying-Bin Liu, Shu-You Peng, Jin-Zhong Pang, Zhi-Fei Wang, Jian Cheng, Guo-Liang Shen, Yuan-Biao Zhang
De-Fei Hong, Shu-You Peng, Zhi-Fei Wang, Jian Cheng, Guo-Liang Shen, Yuan-Biao Zhang, Department of Hepatobiliary, Pancreatic Surgery and Minimally Invasive Surgery, Zhejiang Provincial People’s Hospital, Hangzhou 310014, Zhejiang Province, China
Ying-Bin Liu, Department of General Surgery, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
Jin-Zhong Pang, Department of General Surgery, the First People’s Hospital of Qingdao Economic and Technical Department Zone, Qingdao 266555, Shandong Province, China
Author contributions: Hong DF, Liu YB and Peng SY designed the clinical study and surgical techniques; Pang JZ, Shen GL and Zhang YB participated in the management of the patients including working as the assistant in the operations; Cheng J did clinical data collection and analysis; Hong DF and Wang ZF wrote the paper.
Institutional review board statement: This work has been improved by the ethics committee of Zhejiang Provincial People’s Hospital.
Informed consent statement: Informed consent was obtained from all the patients at the admission to the hospital.
Conflict-of-interest statement: There is no conflict-of-interest in this clinical study.
Data sharing statement: No additional unpublished data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: De-Fei Hong, MD, FACS, Department of Hepatobiliary, Pancreatic Surgery and Minimally Invasive Surgery, Zhejiang Provincial People’s Hospital, 158 Shangtang Road, Hangzhou 310014, Zhejiang Province, China. hongdefi@163.com
Telephone: +86-571-85893957 Fax: +86-571-85893957
Received: December 31, 2014
Peer-review started: January 1, 2015
First decision: January 22, 2015
Revised: February 22, 2015
Accepted: April 28, 2015
Article in press: April 28, 2015
Published online: July 14, 2015
Processing time: 195 Days and 11.2 Hours
Abstract

AIM: To demonstrate that caudate lobectomy is a valid treatment in cases of hepatocellular carcinoma (HCC) rupture in the caudate lobe based on our experience with the largest case series reported to date.

METHODS: A retrospective study of eight patients presenting with spontaneous rupture and hemorrhage of HCC in the caudate lobe was conducted. Two patients underwent ineffective transarterial embolization preoperatively. Caudate lobectomy was performed in all eight patients. Bilateral approach was taken in seven cases for isolated complete caudate lobectomy. Left-sided approach was employed in one case for isolated partial caudate lobectomy. Transarterial chemoembolization was performed postoperatively in all patients.

RESULTS: Caudate lobectomy was successfully completed in all eight cases. The median time delay from the diagnosis to operation was 5 d (range: 0.25-9). Median operating time was 200 min (range: 120-310) with a median blood loss of 900 mL (range: 300-1500). Five patient remained in long-term follow-up, with one patient becoming lost to follow-up at 3 years and two patients currently alive at 7 and 19 mo. One patient required reoperation due to recurrence. Gamma knife intervention was performed for brain metastasis in another case. Two patients survived for 10 and 84 mo postoperatively, ultimately succumbing to multiple organ metastases.

CONCLUSION: Caudate lobectomy is the salvage choice for HCC rupture in the caudate lobe. Local anatomy and physiologic features of the disease render caudate lobectomy a technically difficult operation. Postponement of surgical intervention is thus recommended while the rupture remains hemodynamically stable until an experienced surgeon becomes available. Prognosis is confounded by numerous factors, but long-term survival can be expected in the majority of cases.

Keywords: Caudate lobectomy; Hepatocellular carcinoma; Emergency; Rupture; Transarterial embolization

Core tip: Management of spontaneous rupture and hemorrhage of hepatocellular carcinoma is seldom reported due to its rareness and severity. This article demonstrates that caudate lobectomy is a valid treatment as well as the salvage choice for management in such cases based on our experience with the largest case series reported to date. Based on limited long-term follow-up data, overall 1-year and 3-year survival rates have been achieved. In addition, delayed surgery is advised over prudent resection until an experienced surgical team becomes available.