STAGED HEPATECTOMY AFTER EMERGENCY TRANSCATHETER ARTERIAL EMBOLIZATION FOR RUPTURED HEPATOCELLULAR-CARCINOMA

Background. Staged hepatectomy after emergency transcatheter arterial embolization (TAE) has been advocated in ruptured hepatocellular carci noma (HCC). However, there have been no reports of clinical series of this strategy. The purpose of this study was to evaluate the protocol of this therapeutic strategy. Methods. Sixteen patients with suspected rupture of HCC were included in the study. After emergency TAE, tumor resectability was assessed, followed by staged hepatectomy or repeate d TAE. The patients were reevaluated with regard to rupture of HCCs. R esults. Primary hemostasis was achieved successfully in all patients. Eleven patients were finally judged to have experienced HCC rupture. S even of them underwent staged hepatectomy; the other four underwent re peated TAE because their tumors wne considered unresectable. Survival lime tended to be longer, but not to a significant extent, in patients who underwent hepatectomy (range, 139 to 1527 days; median, 375 days) than in those treated by TAE alone (range, 43 to 1317 days; median, 1 58 days). Conclusions. Staged hepatectomy after TAE is a rational trea tment for patients with ruptured HCC. Although TAE is highly effective for initial hemostasis, hepatectomy appears to provide better long-te rm survival.