Safety and efficacy of dehydrated ethanol soaking of the operative field in the treatment of spontaneous hepatocellular carcinoma rupture.
BACKGROUND
The aim of our study was to evaluate the clinical safety and value of ethanol surgical field infiltration (ESFI), combined with distilled water peritoneal lavage (DWPL), after hepatectomy in patients with hepatocellular carcinoma (HCC) rupture.


METHODS
Rat liver tissue samples were soaked in dehydrated ethanol for different soaking times, and 18 rats were assigned to three groups that underwent different soaking methods of the hepatectomy cut surface. We retrospectively reviewed 45 patients who underwent hepatectomy for treatment of ruptured HCC. Among these, EFSI combined with DWPL was used in 21 patients (DAW group), with only DWPL used in the other 24 patients (DW group). Clinical outcomes were compared between the two groups.


RESULTS
For in vitro experiments, the depth of coagulation degeneration and necrosis increased with the duration of soaking. For in vivo experiments, rats in all three groups survived until postoperative day 7 without significant postoperative complication. In patients, the rate of post-operation complication was comparable between the two groups (P = 0.398), with no between-group differences in liver function levels. The incidence of peritoneal dissemination was significantly higher for DW than DAW group (P = 0.037). Kaplan-Meier test identified dehydrated ethanol treatment as a significant factor of disease-free survival (DFS) (P = 0.036). On univariate analysis, dehydrated ethanol treatment was associated with better prognostic outcomes, although it was not retained as an independent factor of patient outcome.


CONCLUSIONS
Dehydrated ethanol soaking of the cut surface of the hepatectomy could potentially lower the risk of metastasis and improve the effect of hepatectomy for ruptured HCC as well as showed potential therapeutic value for intraoperative iatrogenic rupture of HCC.
['Sun|Jian|J|', 'Zhu|Yue|Y|', 'Peng|Yao-Rong|YR|', 'Li|Wen-Bin|WB|', 'Zhang|He-Yun|HY|', 'Zhou|Zhen-Yu|ZY|', 'Wang|Lin|L|', 'Ma|An-de|AD|', 'Wang|Jie|J|http://orcid.org/0000-0002-6456-1101']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D000818:Animals D006528:Carcinoma, Hepatocellular D000431:Ethanol D005260:Female D005500:Follow-Up Studies D006498:Hepatectomy D006801:Humans D008113:Liver Neoplasms D008297:Male D008875:Middle Aged D010533:Peritoneal Lavage D011183:Postoperative Complications D011379:Prognosis D051381:Rats D017208:Rats, Wistar D012189:Retrospective Studies D012422:Rupture, Spontaneous D015996:Survival Rate D055815:Young Adult
Dehydrated ethanol Hepatocellular carcinoma Spontaneously rupture