Is transarterial embolization a valuable treatment option for spontaneous rupture of hepatocellular carcinoma: experience from a tertiary care hospital of South-Asia

Aim: Transarterial embolization (TAE) has been found beneficial in treatment of ruptured Hepatocellular carcinoma (HCC) in earlier studies. So far no data is available from Pakistan. The aim of this study was to evaluate clinicopathological characteristics, outcomes of patients presented with spontaneously ruptured, unresectable HCC treated with or without TAE and to evaluate the factors associated with 30-day mortality. Methods: This was a cross sectional study. Patients ≥ 18 years old, presented with spontaneous rupture of unresectable HCC, were evaluated. The outcome measures were control of bleeding, in-hospital mortality, 30day mortality and factors associated with 30-days mortality. Results: Out of 850 patients, 24 patients were diagnosed with spontaneously ruptured HCC. Mean age was 58.29 ± 15.26 years. A total of 11 (45.8%) patients were treated conservatively and 13 (54.2%) underwent TAE. Control of bleeding due to ruptured HCC was significantly higher for those treated via TAE as compared to those who were treated conservatively (92.3% vs. 36.4%, P = 0.008). Overall median duration for which the patients remained alive after HCC rupture was longer for TAE group (39 days vs. 5 days, P = 0.03). In-hospital mortality (30.8% vs.72.7%, P = 0.04) and 30-day mortality was also lower in TAE group (38.5% vs. 90.9%, P = 0.01). Those who underwent TAE had lower risk of mortality then conservative group [odds ratio (OR) 0.25, 95% confidence interval (CI) 0.07-0.90, P = 0.03). Failure to control bleeding was associated with higher 30-day mortality (OR 2.14, 95% CI 1.24-3.68, P = 0.009). Conclusion: Ruptured HCC is a life threatening complication requiring early diagnosis and treatment. TAE is an effective and well-tolerated treatment in the management of ruptured HCC.