Treatment of spontaneously ruptured hepatocellular carcinoma: use of laparoscopic microwave ablation and washout

Background: Ruptured, or bleeding, hepatocellular carcinoma (rHCC) is a relatively rare disease pre-sentation associated with high acute mortality rates. This study sought to evaluate outcomes following laparoscopic microwave ablation (MWA) and washout in rHCC. Methods: A retrospective single-center review was performed to identify patients with rHCC (2008-2018). The treatment algorithm consisted of transarterial embolization (TAE) or trans-arterial chemoembolization (TACE) followed by laparoscopic MWA and washout. Results: Fifteen patients with rHCC were identified (n = 5 single lesion, n = 5 multifocal disease, n = 5 extrahepatic metastatic disease). Median tumor size was 83 mm (range 5-228 mm), and 10 of 15 un-derwent TAE or TACE followed by laparoscopic MWA/washout. One patient required additional treat-ment for bleeding after MWA with repeat TAE. Thirty-day mortality was 6/15. For those patients discharged (n = 9), additional treatments included chemotherapy (n = 5), TACE (n = 3), and/or partial lobectomy (n = 2). Median follow-up was 18.2 months and median survival was 431 days (range 103-832) (one-year survival n = 7; two-year survival n = 4; three-year survival n = 3). Six patients had post-operative imaging from which one patient demonstrated recurrence. Conclusion: Using laparoscopic MWA with washout may offer advantage in the treatment of ruptured HCC. It not only achieves hemostasis but also could have oncologic benefit by targeting local tumor and decreasing peritoneal carcinomatosis risk.

Automated summary

Laparoscopic microwave ablation with washout may offer advantages in treating ruptured HCC by achieving hemostasis and potentially reducing the risk of peritoneal carcinomatosis through targeting local tumors.