A retrospective review of transcatheter hepatic arterial embolisation for ruptured hepatocellular carcinoma.

Abstract

Background: Hepatocellular carcinoma (HCC) is a disease with a high prevalence in South East Asia. It is not uncommon to encounter rupture of the tumour in an emergency situation. Operative measures in this situation are often associated with high mortality rates. Transcatheter arterial embolisation (TAE) appears to be an effective alternative to surgery and is increasingly used by many centres. In this study, we have reviewed the outcome of our patients after receiving TAE and tried to identify prognostic indicator(s).

Patients and methods: From 1996 to 2000, we had retrospectively reviewed the outcome of 31 patients who had undergone TAE for rupture of HCC and compared their survival with respect to different prognostic indicators.

Results: The were 31 patients with a mean age of 53 years. At the time of rupture, 19 patients had Child's A, 5 Child's B and 7 of Child's C disease. The most common presentation was abdominal pain (14 patients). Bleeding was successfully arrested in all 31 patients. The most common complication was fever (13 patients). The overall mean survival was 126 days. Eight patients died within 30 days of admission, the major cause of death was liver failure, which occurred in 6 patients. In addition, we had also postulated several prognostic indicators for patients' survival. The results showed that only those with a bilirubin level below 50 umol/L and who presented with shock had a poor outcome.

Conclusion: TAE should be considered in the initial management of patients with ruptured HCC. It is effective in arresting tumour bleeding and allows the patient to have subsequent definitive management.