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Ruptured Hepatocellular Carcinoma-Experience in a Tertiary Centre in Western Australia

Received: 15 September 2018     Accepted: 8 October 2018     Published: 7 November 2018
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Abstract

Hepatocellular carcinoma (HCC) is a leading cause of cancer-related deaths worldwide. Spontaneous tumour rupture (STR) is uncommon, with incidence rates around 10-15% in Asia, but below 3% in Western countries. Nonetheless, serious complications lead to high mortality rates. To our knowledge, experience of HCC rupture has not been published in Australia. We identified 9 retrospective cases of ruptured HCC from 2008 to 2017 through patient case notes, electronic laboratory system, and imaging reports. Our case series presents 8 male and 1 female patient with a mean age of 56 years, and a median 11 month follow-up period. Sixty-six percent of patients were non-cirrhotic, and 33% cirrhotic, with a median post- tumour rupture survival rate of 10 months and 12 months, respectively. Seventy-eight percent of patients presented with abdominal pain and a mean tumour size of 8cm at time of rupture. Initial management involved: trans-arterial chemoembolisation (TACE)/ trans-arterial embolisation (TAE) in 4 patients, emergency hepatic resection in 3 patients, sorafenib in 1 patient and conservative/ supportive treatment in 1 patient. Reasons for our low HCC rupture incidence at 0.3% could be due to: none of our patients experiencing rebleeding (one of the common causes of mortality); strict surveillance programmes in Australia identifying early tumours; and majority of our patients being younger and non-cirrhotic with a better underlying liver reserve at time of rupture, and therefore improved outcomes.

Published in International Journal of Gastroenterology (Volume 2, Issue 1)
DOI 10.11648/j.ijg.20180201.14
Page(s) 18-23
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2018. Published by Science Publishing Group

Keywords

Ruptured Hepatocellular Carcinoma, Trans-Arterial Chemoembolisation, Trans-Arterial Embolisation

References
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Cite This Article
  • APA Style

    Sarah Ng, Justin Chin, Sudhakar Rao, Nick Kontorinis, James Anderson, et al. (2018). Ruptured Hepatocellular Carcinoma-Experience in a Tertiary Centre in Western Australia. International Journal of Gastroenterology, 2(1), 18-23. https://doi.org/10.11648/j.ijg.20180201.14

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    ACS Style

    Sarah Ng; Justin Chin; Sudhakar Rao; Nick Kontorinis; James Anderson, et al. Ruptured Hepatocellular Carcinoma-Experience in a Tertiary Centre in Western Australia. Int. J. Gastroenterol. 2018, 2(1), 18-23. doi: 10.11648/j.ijg.20180201.14

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    AMA Style

    Sarah Ng, Justin Chin, Sudhakar Rao, Nick Kontorinis, James Anderson, et al. Ruptured Hepatocellular Carcinoma-Experience in a Tertiary Centre in Western Australia. Int J Gastroenterol. 2018;2(1):18-23. doi: 10.11648/j.ijg.20180201.14

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  • @article{10.11648/j.ijg.20180201.14,
      author = {Sarah Ng and Justin Chin and Sudhakar Rao and Nick Kontorinis and James Anderson and Suresh Navadgi and Jee Kong and Adam Doyle and Wendy Cheng},
      title = {Ruptured Hepatocellular Carcinoma-Experience in a Tertiary Centre in Western Australia},
      journal = {International Journal of Gastroenterology},
      volume = {2},
      number = {1},
      pages = {18-23},
      doi = {10.11648/j.ijg.20180201.14},
      url = {https://doi.org/10.11648/j.ijg.20180201.14},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijg.20180201.14},
      abstract = {Hepatocellular carcinoma (HCC) is a leading cause of cancer-related deaths worldwide. Spontaneous tumour rupture (STR) is uncommon, with incidence rates around 10-15% in Asia, but below 3% in Western countries. Nonetheless, serious complications lead to high mortality rates. To our knowledge, experience of HCC rupture has not been published in Australia. We identified 9 retrospective cases of ruptured HCC from 2008 to 2017 through patient case notes, electronic laboratory system, and imaging reports. Our case series presents 8 male and 1 female patient with a mean age of 56 years, and a median 11 month follow-up period. Sixty-six percent of patients were non-cirrhotic, and 33% cirrhotic, with a median post- tumour rupture survival rate of 10 months and 12 months, respectively. Seventy-eight percent of patients presented with abdominal pain and a mean tumour size of 8cm at time of rupture. Initial management involved: trans-arterial chemoembolisation (TACE)/ trans-arterial embolisation (TAE) in 4 patients, emergency hepatic resection in 3 patients, sorafenib in 1 patient and conservative/ supportive treatment in 1 patient. Reasons for our low HCC rupture incidence at 0.3% could be due to: none of our patients experiencing rebleeding (one of the common causes of mortality); strict surveillance programmes in Australia identifying early tumours; and majority of our patients being younger and non-cirrhotic with a better underlying liver reserve at time of rupture, and therefore improved outcomes.},
     year = {2018}
    }
    

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  • TY  - JOUR
    T1  - Ruptured Hepatocellular Carcinoma-Experience in a Tertiary Centre in Western Australia
    AU  - Sarah Ng
    AU  - Justin Chin
    AU  - Sudhakar Rao
    AU  - Nick Kontorinis
    AU  - James Anderson
    AU  - Suresh Navadgi
    AU  - Jee Kong
    AU  - Adam Doyle
    AU  - Wendy Cheng
    Y1  - 2018/11/07
    PY  - 2018
    N1  - https://doi.org/10.11648/j.ijg.20180201.14
    DO  - 10.11648/j.ijg.20180201.14
    T2  - International Journal of Gastroenterology
    JF  - International Journal of Gastroenterology
    JO  - International Journal of Gastroenterology
    SP  - 18
    EP  - 23
    PB  - Science Publishing Group
    SN  - 2640-169X
    UR  - https://doi.org/10.11648/j.ijg.20180201.14
    AB  - Hepatocellular carcinoma (HCC) is a leading cause of cancer-related deaths worldwide. Spontaneous tumour rupture (STR) is uncommon, with incidence rates around 10-15% in Asia, but below 3% in Western countries. Nonetheless, serious complications lead to high mortality rates. To our knowledge, experience of HCC rupture has not been published in Australia. We identified 9 retrospective cases of ruptured HCC from 2008 to 2017 through patient case notes, electronic laboratory system, and imaging reports. Our case series presents 8 male and 1 female patient with a mean age of 56 years, and a median 11 month follow-up period. Sixty-six percent of patients were non-cirrhotic, and 33% cirrhotic, with a median post- tumour rupture survival rate of 10 months and 12 months, respectively. Seventy-eight percent of patients presented with abdominal pain and a mean tumour size of 8cm at time of rupture. Initial management involved: trans-arterial chemoembolisation (TACE)/ trans-arterial embolisation (TAE) in 4 patients, emergency hepatic resection in 3 patients, sorafenib in 1 patient and conservative/ supportive treatment in 1 patient. Reasons for our low HCC rupture incidence at 0.3% could be due to: none of our patients experiencing rebleeding (one of the common causes of mortality); strict surveillance programmes in Australia identifying early tumours; and majority of our patients being younger and non-cirrhotic with a better underlying liver reserve at time of rupture, and therefore improved outcomes.
    VL  - 2
    IS  - 1
    ER  - 

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Author Information
  • Department of Gastroenterology & Hepatology, Royal Perth Hospital, Perth, Australia

  • Department of Gastroenterology & Hepatology, Royal Perth Hospital, Perth, Australia

  • Department of General Surgery, Royal Perth Hospital, Perth, Australia

  • Department of Gastroenterology & Hepatology, Royal Perth Hospital, Perth, Australia

  • Department of Radiology, Royal Perth Hospital, Perth, Australia

  • Department of General Surgery, Royal Perth Hospital, Perth, Australia

  • Department of Gastroenterology & Hepatology, Royal Perth Hospital, Perth, Australia

  • Department of Gastroenterology & Hepatology, Royal Perth Hospital, Perth, Australia

  • Department of Gastroenterology & Hepatology, Royal Perth Hospital, Perth, Australia

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