Emergency transarterial embolization followed by staged hepatectomy versus emergency hepatectomy for ruptured hepatocellular carcinoma: a single-center, propensity score matched analysis

Purpose To compare the feasibility and efficacy of emergency transarterial embolization (TAE) followed by staged hepatectomy (SH) with emergency hepatectomy (EH) for ruptured hepatocellular carcinoma (HCC). Methods Between January 2012 and December 2017, 102 patients with HCC rupture received EH or emergency TAE followed by SH in our center. Patients were followed until April 2019. Propensity score matching (PSM) analysis was used at a 1:2 ratio, resulting in 20 patients in the SH group and 40 patients in the EH group. We retrospectively compared the operative variables, recurrence status, disease-free survival (DFS), and overall survival (OS) of patients between the two matched groups. Results Compared with the matched EH group, the SH group showed significantly decreased perioperative blood loss or blood transfusion, shortened intraoperative duration of clamping and postoperative hospital stay (P < 0.05), while achieving comparable long-term OS (SH group: 39.0 months vs. EH group: 38.1 months,P = 0.342). There was no significant difference in the peritoneal metastasis rate (SH group: 20.0% vs. EH group: 25.6%,P = 0.874), recurrence rate (SH group: 65.0% vs. EH group: 71.8%,P = 0.333) or DFS (SH group: 9.4 months vs. EH group: 7.7 months,P = 0.602) between the two matched groups. Conclusion For resectable ruptured HCC, emergency TAE of rupture which followed by SH, could bring patients about intraoperative and postoperative benefits when compared to EH. Moreover, this combination treatment will not increase the rate of peritoneal metastasis or recurrence, and might achieve favorable survival benefits for patients.