To explore the transformational resection strategy for rupture and hemorrhage of giant hepatocellular carcinoma (HCC).

Clinical data of 1 patient with rupture and hemorrhage of giant HCC admitted to Zhujiang Hospital of Southern Medical University in November 2018 were retrospectively analyzed. The 56-year-old male patient was admitted to our hospital due to dull pain in the right upper abdomen for 2 weeks. A history of hepatitis B for over 20 years was noted. Upper abdominal swelling and a palpable mass in the right upper abdomen with the lower margin reaching three-finger away under the rib, were found in physical examination. The AFP level was 3 433 μg/L. A large low-density shadow could be seen in the left liver lobe by CT scan. The initially diagnosis was primary liver cancer. The informed consent of this patient was obtained and the local ethical committee approval was received. The diagnosis and treatment strategy and outcome were observed.

After admission, the rupture of tumor occurred. Transcatheter arterial embolization (TAE) was performed emergently. Subsequently, TACE combined with molecular targeted drug downstaging transformational therapy were given for 3 months. At 16 weeks after TAE, the tumors were found significantly reduced by three-dimensional visualization. Then, hepatectomy was performed. The tumors in the left lobe were completely resected. The tumors in the right lobe were ablated by intraoperative ultrasound-guided Habib radiofrequency. Postoperative pathological examination confirmed the diagnosis of stage G2 HCC, no vascular or nerve invasion was observed. Postoperatively, the patient was given with lavatinib and Huaier granules. Until the submission date, the patient has survived for over 23 months.

TAE combined with molecular targeted drugs and other interventions are recommended for patients with rupture and hemorrhage of giant HCC. Secondary surgical resection after tumor transformational downstaging treatment can still improve the quality of life.