Impact Of Emergency And Staged Hepatectomy On Peritoneal Metastases For Resectable Spontaneous Ruptured Hepatocellular Carcinoma

ObjectiveTo study the impact of emergency and staged hepatectomy on peritoneal metastases for resectable spontaneous ruptured hepatocellular carcinoma(HCC),and investigate the impact of surgery timing-selecting on peritoneal metastases of postoperative HCC patientsMethodsWe retrospectively studied 38 patients with spontaneous ruptured HCC treated in our hospital from August 2011 to January 2016.These patients were divided into emergency group who underwent hepatectomy within 24 hours at admission,and staged group who underwent the procedure one week after admission.Perioperative events,overall survival(OS)and disease-free-survival(DFS)rates,incidence of recurrent and metastatic disease were compared between the two groups.ResultsThe perioperative blood loss and transfusion were much more in emergency group than staged group(both P <0.05).Nevertheless,the incidences of postoperative mortality was not significantly different(6% vs 0%,P >0.05).The median survival time(MST)was 22.5months in emergency group versus 14.2 months in staged group.The 6-month,1-year,3-year OS rates in emergency group were 88.2%,82.4% and 30.3%,respectively,and 6-month,1-year,3-year DFS rates were 81.3%,54.7% and 27.3%.The 1-year OS and 6-month DFS rates of the emergency group were higher than those of the staged group(both P <0.05).The incidence of peritoneal metastasis in staged group was higher than that in emergency group,but it was not significantly different(38.1% vs 29.4%,P >0.05).Univariate and multivariate analysis revealed that tumor size ?10cm and AFP >10000ug/L were significant risk factors of peritoneal metastasis after hepatectomy for patients with spontaneous HCC rupture.ConclusionsEmergency hepatectomy would warrant a better short-term prognosis compared with staged hepatectomy for the HCC patients with spontaneous rupture.Staged hepatectomy would not raise the possibility of postoperative peritoneal metastasis.The predictors of Tumor size ?10cm and AFP >10000ug/L were risk factors for peritoneal metastasis after hepatectomy for spontaneously ruptured HCC patients.