wy chu, surgery, tuen mun hospital, ntwc. initial management as a hst in rupture hcc
TRANSCRIPT
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WY Chu, Surgery, Tuen Mun Hospital, NTWC
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Initial management as a HST in rupture HCC
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Catastrophic event Initial management is important
Stop bleeding
Identify potential long term survivors
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Chan SY, F/43, @ 15.7.2007
Known HBV carrier, L lobe liver mass Sudden onset RUQ pain with shock BP 70/45 P110, confused Bedside USG: FF in Morrison’s pouch Child’s A, Hb 12 g/dL CT abdomen with contrast
Hemodynamically unstable
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Chan SY, F/43, @ 15.7.2008 Laparotomy: 4 cm S2&3 ruptured HCC,
cirrhosis, 2L blood with clot Perihepatic packing & LHA ligation at
falciform ligament level Further resuscitation in ICU 2nd stage laparotomy 24 hrs later Left lateral sectionectomy Discharged post-op D7 Last FU 8.8.2008: well no recurrence
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TMH series 2004-2007
Survival:
32 months (12-48) Survival:
7 months
(3-8)
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Early diagnosis
? Men? Younger age? Trauma hx
? Known HCC? Cirrhosis
? HBV / HCV
? Shock? RUQ/
epigastric pain ? Abd distension/
peritonism ?USG : FF
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Early Resuscitation
Correct coagulopath
y
Blood Transfusion
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Assessment of patient
Independent poor prognostic factors for 30 day mortality
Tan et al, ANZJ Surg 2006
Candidate for liver resectionWang et al, ANZJ Surg 2008
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Early CT scan
? Peripheral location? Well-
defined tumor
? Portal vein thrombosis
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Early Transarterial embolization TAE
To stop arterial bleeding Success rate: 83-100% Liver failure rate: 19-29% Re-rupture rate: up to 35%
Lai et al, Arch Surg 2006
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Early operation
Open hemostasis Operable and unstable Stop the venous bleeding
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Liver resection
Survival benefit can be observed in patient with curative liver resection.
Lai et al, Arch Surg 2006
One stage resection: shorter hospital stayLiu et al, World J Surg 2005
TMH: 2nd staged operation 24 hours later
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Summary Life threatening event Multidiscriplinary approach Stop bleeding
Identify the potential candidate who can have long survival after Rx
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ENDThank you