Patients with Spontaneously Ruptured Hepatocellular Carcinoma Benefit from Staged Surgical Resection after Successful Transarterial Embolization

Background: Surgical resection of spontaneously ruptured hepatocellular carcinoma (HCC) after successfultransarterial embolization (TAE) remains controversial. The aim of this study was to investigate its efficacyin a series of cases. Materials and
Methods: We retrospectively examined ruptured HCC cases from Jan 2000to Dec 2008; all of these 126 cases received TAE as the initial therapy. Subsequently, 74 cases received stagedsurgical resection, and the remaining 52 cases underwent repeated TACE. The baseline demographic data, tumorcharacteristics, and long term survival were recorded and compared.
Results: The demographic and baselinecharacteristics were comparable between the hepatic resection and TACE groups; furthermore, no significantdifference in the tumor characteristics was detected between the two groups. The differences in in-hospital, 30-day and 90-day mortality between the two groups were not significant (P>0.05). However, the 1-, 3-, and 5-yearoverall survival rates were 85.1%, 63.5%, and 37.8%, respectively, in the hepatic resection group, which weresignificantly higher than those in the TACE group (69.2%, 46.2%, and 17.3%, respectively, P=0.004). Univariateand multivariate analyses indicated that these patients benefitted from hepatic resection compared with TACEwith respect to long-term outcomes.
Conclusions: Staged hepatic resection after TAE is an effective treatmentthat results in superior long-term survival to repeated TACE.