Study of the Clinical Effects of Concomitant Splenectomy in Patients with Hepatocellular Carcinoma Accompanied with Cirrhosis and Hypersplenism

OBJECTIVE To discuss the clinical efects of concomitant splenectomy in hepatocellular carcinoma patients accompanied with cirrhosis and hypersplenism

METHODS Sixty-seven patients who had hepatocellular carcinoma (HCC) accompanied with hypersplenism from December 1999 to March 2002 were reviewed retrospectively. Thirty-eight patients underwent liver and spleen united resection (splenectomy group) and 29 patients received a hepatectomy (non-splenectomy group).One day before operation and 7 days after operation, the concentration of vascular endothelium growth factor (VEGF) in peripheral blood and splenic venous blood were compared between the two groups.

RESULTS The increase of PLT and WBC was significantly higher in patients who underwent concomitant splenectomy compared to patients who did not receive a splenectomy (P<0.05). The occurrence of complications was 28.9% (11/38) in the splenectomy group and 20.6% (6/29) in the non-splenectomy group, and the recurrence rate one year later was 21.1 %(8/38) in the splenectomy group and 20.6% (6/29) in the non-splenectomy group. There was no significant difference in occurrence of complications and recurrence rates between the two groups. The concentration of VEGF was not significantly different between peripheral blood versus splenic venous blood. Twenty-nine patients in the splenectomy group received hepatic arterial chemoembolization 1-3 times successfully after operation, but in the non-splenectomy group there were 7 patients who had to stop receiving the successive treatment because the PLT and WBC were too low.

CONCLUSION Combined splenectomy is helpful to raise the PLT and WBC count and enable patients to receive subsequent chemoembolization. Early recurrence and metastases are not significantly different between patients with and without splenectomy.