Tackling the Unyielding Challenge of Necrotic Unresectable Hepatocellular Carcinoma: A Liver Necrosectomy Approach for Intratumoral Hemorrhage and Abscess Resolution

TL;DR

This paper discusses a surgical approach to treat advanced liver cancer that cannot be removed, focusing on resolving tumor-related complications like bleeding and abscesses.

Contribution

The paper introduces a liver necrosectomy approach for managing intratumoral hemorrhage and abscesses in unresectable hepatocellular carcinoma.

Findings

Intratumoral hemorrhage and abscesses in unresectable HCC can be effectively managed with timely surgical intervention.

Non-surgical management of advanced HCC can lead to severe complications requiring urgent surgical treatment.

Surgical necrosectomy is a viable option when other curative treatments are not possible.

Abstract

Hepatocellular carcinoma (HCC) is one of the most common causes of gastrointestinal and hepatobiliary cancer worldwide. Chronic liver disease and cirrhosis persist as the most common risk factors, typically linked to instances of alcohol abuse or viral infections, notably hepatitis B and hepatitis C infection. Diagnosis can be made using patient history and image studies as there is no need for pathological confirmation. The only curative treatment is surgical resection, and in cases where the tumor is unresectable, as the one presented in this case, and when there are no contraindications, the only option is an orthotopic liver transplantation. This malignancy is not only associated with high mortality but also high morbidity associated with severe complications, such as hemorrhage, necrosis, and infection of the tumor. The significant relevance of this case lies in its capacity to illustrate that despite remaining in non-surgical management for months when an acute complication presented, it was timely identified and surgically treated. The emergence of complications, such as necrosis accompanied by abscess formation and intratumoral hemorrhage, represents an indication for prompt surgical management.

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