Splenectomy in chronic hepatic disorders: portal vein thrombosis and improvement of liver function.

Abstract

BACKGROUND:

Splenectomy is gaining increasing importance for cirrhotic patients with hypersplenism. However, its safety and efficacy for patients with chronic liver disease remain unclear.

METHODS:

We retrospectively examined the medical records of 38 consecutive cirrhotic patients who underwent splenectomy or simultaneous hepatectomy and splenectomy for hepatocellular carcinoma.

RESULTS:

White blood cell and platelet counts significantly increased 3 months after splenectomy. Serum levels of total bilirubin and prothrombin time significantly improved 1 year after splenectomy. Interferon therapy was administered to 25 patients after splenectomy. A sustained viral response was achieved in 8 patients (42%). The total incidence of portal or splenic vein thrombosis (PSVT) detected by postoperative dynamic computed tomography was 13/38 (34.2%). Multivariate analysis revealed preoperative spleen volume (SV) to be the sole independent predictor of postoperative PSVT. Receiver-operator characteristic curve analysis showed that a cut-off SV of 450 ml corresponded to a sensitivity of 85% and a specificity of 56%.

CONCLUSIONS:

Splenectomy improved the liver function and facilitated effective interferon therapy in cirrhotic patients with hypersplenism, although preoperative SV was frequently associated with postoperative PSVT.

• Authors: Yuichiro Ushitora, Hirotaka Tashiro, Shoichi Takahashi, Hironobu Amano, Akihiko Oshita, Tsuyoshi Kobayashi, Kazuaki Chayama, Hideki Ohdan
• Journal: Digestive surgery (Dig Surg) Vol. 28 Issue 1 Pg. 9-14 ( 2011) ISSN: 1421-9883 [Electronic] Switzerland
• PMID: 21293126 (Publication Type: Journal Article)
• Copyright: Copyright © 2011 S. Karger AG, Basel.

Chemical References

• Antiviral Agents
• Interferons
• Bilirubin

Topics

• Adult
• Aged
• Antiviral Agents (therapeutic use)
• Bilirubin (blood)
• Female
• Hepatectomy (adverse effects)
• Humans
• Hypersplenism (pathology, surgery)
• Interferons (therapeutic use)
• Leukocyte Count
• Liver (physiopathology)
• Liver Cirrhosis (physiopathology, surgery)
• Male
• Middle Aged
• Multivariate Analysis
• Organ Size
• Platelet Count
• Portal Vein (physiopathology)
• Prothrombin Time
• ROC Curve
• Retrospective Studies
• Spleen (pathology)
• Splenectomy (adverse effects)
• Splenic Vein (physiopathology)
• Venous Thrombosis (etiology, physiopathology)