Delayed versus emergency hepatectomy for ruptured hepatocellular carcinoma

Background and Aims : Ruptured hepatocellular carcinoma (HCC) is a life-threatening complication of HCC. Delayed hepatectomy after successful hemostasis or emergency hepatectomy is the controversial issue of the treatment for resectable ruptured HCC. The aim of this study was to evaluate outcomes of these procedures for ruptured HCC. Materials and Methods : From 2001 to 2005, hepatectomy for HCC was performed by the author on 62 patients, Of these, 16 patients had ruptured HCC. Emergency hepatectomy was performed in 10 patients and delayed hepatectomy in the remaining 6. Clinical data and outcomes following hepatectomy for ruptured HCC were reviewed and analyzed retrospectively. Results : In emergency hepatectomy group, there was one complication of transient gastric atony and one of postoperative death from massive variceal bleeding. A 1-year survival rate was 60% with a mean survival of 22 months. No postoperative complication and death was found in delayed hepatectomy patients but three died in 8, 11 and 14 months due to lung metastasis. A 1-year survival rate was 67% with a mean survival of 14 months. No statistically significant difference in morbidity and mortality rate was found between the emergency hepatectomy group and delayed or elective hepatectomy group. There was no significant difference in overall survival between emergency and delayed hepatectomy groups. Conclusion : Emergency hepatectomy may be a life-saving procedure for resectable ruptured HCC patients who have massive and continuous bleeding, particularly if emergency transarterial embolization is not available. To avoid difficult delayed hepatectomy and with concern for the rapid progression of cancer, delayed hepatectomy should be performed as soon as possible

Predictive Factors for a Long Hospital Stay in Patients Undergoing Laparoscopic Cholecystectomy

Background. Although the advantages of laparoscopic cholecystectomy (LC) over open cholecystectomy are immediately obvious and appreciated, several patients need a postoperative hospital stay of more than 24 hours. Thus, the predictive factors for this longer stay need to be investigated. The aim of this study was to identify the causes of a long hospital stay after LC. Methods. This is a retrospective cohort study with 500 successful elective LC patients being included in the analysis. Short hospital stay was defined as being discharged within 24 hours after the operation, whereas long hospital stay was defined as the need for a stay of more than 24 hours after the operation. Results. Using multivariable analysis, ten independent predictive factors were identified for a long hospital stay. These included patients with cirrhosis, patients with a history of previous acute cholecystitis, cholangitis, or pancreatitis, patients on anticoagulation with warfarin, patients with standard-pressure pneumoperitoneum, patients who had been given metoclopramide as an intraoperative antiemetic drug, patients who had been using abdominal drain, patients who had numeric rating scale for pain > 3, patients with an oral analgesia requirement > 2 doses, complications, and private ward admission. Conclusions. LC difficulties were important predictive factors for a long hospital stay, as well as medication and operative factors