S. H. Kim MD; D. Y. Kim MD, PhD; J. H. Lim MD; S. U. Kim MD; G. H. Choi MD; S. H. Ahn MD, PhD; J. S. Choi MD, PhD; K. S. Kim MD, PhD.
Role of splenectomy in patients with hepatocellular carcinoma and hypersplenism
Article first published online: 17 SEP 2012
© 2012 The Authors. ANZ Journal of Surgery © 2012 Royal Australasian College of Surgeons
ANZ Journal of Surgery
Volume 83, Issue 11, pages 865–870, November 2013
How to Cite
Kim, S. H., Kim, D. Y., Lim, J. H., Kim, S. U., Choi, G. H., Ahn, S. H., Choi, J. S. and Kim, K. S. (2013), Role of splenectomy in patients with hepatocellular carcinoma and hypersplenism. ANZ Journal of Surgery, 83: 865–870. doi: 10.1111/j.1445-2197.2012.06241.x
- Issue published online: 29 OCT 2013
- Article first published online: 17 SEP 2012
- Manuscript Accepted: 27 JUN 2012
- hepatocellular carcinoma;
Hypersplenism with thrombocytopenia is a common complication of cirrhosis with portal hypertension. We evaluated the role of splenectomy in patients with hepatocellular carcinoma (HCC) in terms of the improvement of biochemical indices and liver volume.
Nineteen patients with HCC underwent liver resection and splenectomy from January 2000 to December 2009. Thirty-nine patients who underwent liver resection during the same period were enrolled as case-matched controls. We performed a retrospective review of prospectively collected data. We analysed the results of biochemical tests, disease-free survival and overall survival and measured the liver volume before and at 90 days after operation.
Preoperative white blood cell counts (P = 0.001), platelet counts (P = 0.021), total bilirubin (P ≤ 0.001) and prothrombin time by international normalized ratio (P = 0.043) were significantly different. However, these results had converged to similar levels 90 days after the operation. The degree of increment in liver volume were similar (P = 0.763). In splenectomy group, portal vein thrombosis developed in eight patients and all patients except one recovered using only conservative treatments. There was an operative mortality because of liver failure by thrombosis.
Although splenectomy may induce thrombosis, liver failure and subsequent mortality, splenectomy may improve liver function and expand the indication of liver resection if postoperative management is conducted conservatively.