Surgical outcome and survival of patients with spontaneous rupture and bleeding of hepatocellular carcinoma after hepatectomy

Objective To investigate the surgical outcome and survival of patients with spontaneous rupture and bleeding of hepatocellular carcinoma after hepatectomy.Methods A total of 68 patients with spontaneous rupture and bleeding of hepatocellular carcinoma who were admitted to Rizhao Municipal Hospital of Traditional Chinese Medicine from January 2008 to June 2016 and underwent hepatectomy were enrolled, and their perioperative conditions, postoperative survival, and risk factors were analyzed.The Kaplan-Meier method was used to calculate cumulative survival rate;the log-rank test was used for the univariate analysis of prognostic factors, and the Cox regression model was used for the multivariate analysis of the risk factors with statistical significance identified by the univariate analysis.Results Of all patients, 3 died after surgery, resulting in a perioperative mortality rate of 4.41%;among the other 65 patients, 14 (21.54%) experienced serious complications after surgery.A total of 61 patients were followed up, and the follow-up rate was 93.85%.The median overall survival time was 14.0 months and the 1-, 3-, and 5-year cumulative overall survival rates were 52.5%, 28.6%, and 11.8%, respectively.The median disease-free survival time was 10.9 months and the 1-, 3-, and 5-year cumulative disease-free survival rates were47.5%, 21.2%, and 10.6%, respectively.The univariate analysis showed that overall postoperative survival time was associated with Child-Pugh class, alpha-fetoprotein level, tumor size, number of tumors, vascular invasion, and serious complications after surgery (χ2=4.201, 5.291, 5.926, 6.327, 5.062, and 5.028, all P<0.05) .The Cox multivariate analysis showed that a tumor diameter of≥10 cm (relative risk[RR]=3.688, 95%confidence interval[CI]:1.211-11.227, P=0.034) , multiple tumors (RR=4.158, 95%CI:1.092-15.827, P=0.027) , vascular invasion (RR=0.206, 95%CI:0.078-0.540, P=0.034) , serious complications after surgery (RR=0.283, 95%CI:0.086-0.929, P=0.025) were independent risk factors for overall postoperative survival time.ConclusionPatients with spontaneous rupture and bleeding of hepatocellular carcinoma have high perioperative mortality rate and incidence rate of complications after hepatectomy, with poor overall survival after surgery.The patients with large tumors, multiple tumors, vascular invasion,