Abstract
BACKGROUND: Spontaneous rupture of hepatocellular carcinoma (srHCC) carries a high risk of peritoneal metastasis and poor prognosis. While hyperthermic intraperitoneal chemotherapy (HIPEC) is established for peritoneal metastases in other cancers, its prophylactic role after radical resection of srHCC remains undefined. This study evaluated the efficacy and safety of HIPEC in improving outcomes for srHCC patients post-hepatectomy. METHODS: In this retrospective study, 77 patients with srHCC undergoing hepatectomy (2016-2022) were categorized into the HR-HIPEC group (n=30) and the non-HIPEC group (n=47). Clinical features and survival data were analyzed. RESULTS: The HR-HIPEC group demonstrated significantly superior median overall survival (OS: 44 vs 35 months; P=0.027) and recurrence-free survival (RFS: 44 vs 25 months; P=0.007). The 3-year OS (73.85% vs 44.17%) and RFS (54.72% vs 24.47%) rates were also higher with HIPEC. Multivariate analysis identified HIPEC as an independent protective factor for both OS (HR=9.301, P<0.001) and RFS (HR=2.159, P=0.044). Postoperative recovery, morbidity, and mortality were comparable between groups. Subgroup analysis of HIPEC regimens (gemcitabine/cisplatin vs oxaliplatin/5-FU/folinic acid) revealed no significant differences in efficacy, though the latter was associated with transiently lower hemoglobin (P=0.006). CONCLUSION: Prophylactic HIPEC is a safe and feasible adjunct to hepatectomy that significantly improves survival outcomes in srHCC patients without increasing perioperative risks. The choice between the two chemotherapy regimens studied did not affect efficacy, warranting further investigation to optimize protocols.