Benefits of Splenectomy and Curative Treatments for Patients with Hepatocellular Carcinoma and Portal Hypertension: a Retrospective Study.

Abstract

BACKGROUND:

We aimed to explore the benefit of splenectomy combined with curative treatments (liver resection or local ablation) for patients with hepatocellular carcinoma and portal hypertension.

METHODS:

The records of 239 patients with hepatocellular carcinoma and portal hypertension undergoing either splenectomy combined with liver resection or local ablation were reviewed retrospectively. Perioperative complications and survival outcome were evaluated, and liver function 1 year later was reassessed according to the Child score.

RESULTS:

The post-hepatectomy liver failure rates and 30-day mortality were 3.3% and 2.1%, respectively. The 1-, 3-, and 5-year overall survival rates were 95.1%, 73%, and 47.5% for patients with Child grade A and 92.2%, 51.2%, and 19.8% for Child grade B, respectively. The median survival time for patients with Child scores of 5, 6, 7, 8, and 9 were 61.5, 51.3, 44.8, 33.7, and 23.4 months, respectively. After multivariable analysis, tumor size, tumor number, post-hepatectomy liver failure, and Child score were independent risk factors for overall survival. Liver function was converted to Child grade A in 98 of 101 patients (97%) who had preoperative Child grade B 1 year after splenectomy.

CONCLUSION:

Patients with hepatocellular carcinoma and portal hypertension can benefit from splenectomy combined with curative treatments, especially those with Child scores of 5, 6, and 7. Liver function improved significantly 1 year after splenectomy in patients with preoperative Child grade B.

• Authors: Youliang Pei, Songshan Chai, Yuxin Zhang, Zhanguo Zhang, Xiaoping Chen, Wanguang Zhang
• Journal: Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract (J Gastrointest Surg) Vol. 23 Issue 11 Pg. 2151-2162 (11 2019) ISSN: 1873-4626 [Electronic] United States
• PMID: 30511133 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Adult
• Carcinoma, Hepatocellular (complications, pathology, surgery)
• Female
• Hepatectomy (methods)
• Humans
• Hypertension, Portal (complications)
• Liver Failure (epidemiology)
• Liver Neoplasms (complications, pathology, surgery)
• Male
• Middle Aged
• Multivariate Analysis
• Retrospective Studies
• Risk Factors
• Splenectomy (methods)
• Survival Rate
• Treatment Outcome
• Tumor Burden