Peritoneal Carcinomatosis Risk and Long-Term Survival Following Hepatectomy for Spontaneous Hepatocellular Carcinoma Rupture: Results of a Multicenter French Study (FRENCH—AFC)

International audience; Background: Spontaneous rupture of hepatocellular carcinoma (HCC) remains a life-threatening complication, with a reported mortality rate of between 16 and 30% and an incidence rate of approximately 3% in Europe.

Survival data and risk factors after ruptured HCC are lacking, especially for peritoneal metastasis (PM).

Objectives: The aims of this study were to evaluate the pattern of recurrence and mortality after hepatectomy for ruptured HCC, and to focus on PM.Methods: We retrospectively reviewed the files of patients admitted to 14 French surgical centers for spontaneous rupture of HCC between May 2000 and May 2012.

Results: Overall, 135 patients were included in this study.

The median disease-free survival and overall survival (OS) rates were 16.1 (11.0-21.1) and 28.7 (26.0-31.5) months, respectively, and the median follow-up period was 29 months.

At last follow-up, recurrences were observed in 65.1% of patients (n = 88).

The overall rate of PM following ruptured HCC was 12% (n = 16).

Surgical management of PM was performed for six patients, with a median OS of 36.6 months.

An α-fetoprotein level > 30 ng/mL (p = 0.0009), tumor size at rupture > 70 mm (p = 0.0009), and vascular involvement (p < 0.0001) were found to be independently associated with an increased likelihood of recurrence.

No risk factor for PM was observed.Conclusion: This large-cohort French study confirmed that 12% of patients had PM after ruptured HCC.

A curative approach may be an option for highly selected patients with exclusive PD because of the survival benefit it could provide.