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Open Access
CC BY 4.0 · Surg J (N Y) 2020; 06(02): e112-e117
DOI: 10.1055/s-0040-1710530
Case Report
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Multimodality Management of Ruptured Large Hepatocellular Carcinoma and Its Recurrence: Rupture at Presentation Should Not Rupture Hope of Long-Term Survival

Gunjan S. Desai
1   Department of Surgical Gastroenterology, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India
,
Prasad M. Pande
1   Department of Surgical Gastroenterology, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India
,
Rajvilas A. Narkhede
2   Department of Surgical Gastroenterology, Dr. Balabhai Nanavati Superspeciality Hospital, Mumbai, Maharashtra, India
,
Prasad K. Wagle
2   Department of Surgical Gastroenterology, Dr. Balabhai Nanavati Superspeciality Hospital, Mumbai, Maharashtra, India
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Publikationsverlauf

04. August 2019

17. März 2020

Publikationsdatum:
16. Juni 2020 (online)

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Abstract

A 59-year-old gentleman with a history of aortic valve replacement presented with spontaneously ruptured hepatocellular carcinoma in right lobe of a hepatitis C virus (HCV)-related chronic liver disease with hemoperitoneum. This acute emergency was managed by transarterial embolization. Right trisectionectomy with preservation of segment IVB after augmentation of future liver remnant by transarterial chemoembolization followed by portal vein embolization was subsequently performed. Sustained virological response to HCV was attained after surgery using sofosbuvir-based regimen. He had a delayed operative bed recurrence 1.5 years later with pulmonary metastatic disease which was managed by operative bed metastasectomy with mesh reconstruction of diaphragm and sorafenib. He is on sorafenib since past 3 years and doing well at 4.5-years follow-up since the first presentation, with significant regression of pulmonary disease and no other disease elsewhere, which highlights that where there is hope, there is a way.

Keywords

sorafenib - hepatocellular carcinoma - trisectionectomy - portal vein embolization

Ethics Statement

The study was performed after the approval of research protocols by the Ethics Committee of Lilavati Hospital and Research Centre in accordance with international agreements (World Medical Association Declaration of Helsinki “Ethical Principles for Medical Research Involving Human Subjects,” amended in October 2013, www.wma.net).


Informed Consent

Written informed consent was obtained from the patient involved in the study.


Author Contributions

G.S.D. performed critical revision of the manuscript for intellectual content, technical support, material support, and study supervision. P.M.P. was responsible for collecting data, analysis of data, preparing the initial draft of the manuscript, and critical revision of the manuscript for intellectual content. R.A.N. performed critical revision of the manuscript for intellectual content, technical support, material support, and study supervision. P.K.W. studied concept, did critical revision of the manuscript for intellectual content, administrative support, technical support, material support, and study supervision.


Financial Disclosure

The authors declare that this study has received no financial support.