title: Splenectomy in patients with hepatocellular carcinoma and hypersplenism.
abstract: BACKGROUND
  Hypersplenism secondary to portal hypertension is common in hepatocellular carcinoma (HCC), but surgeons still face the unresolved problem of how to manage HCC patients with hypersplenism.
  
  
  METHODS
  The records of 48 patients with HCC and hypersplenism were retrospectively examined and postoperative changes in platelet counts, serum total bilirubin levels, and dinical staging scores were analyzed to evaluate the clinical value of combined splenectomy and liver resection. Hepatectomy and splenectomy were performed as a two-stage operation in 13 patients and synchronously in 35.
  
  
  RESULTS
  Postoperative platelet counts were significantly increased, and serum total bilirubin levels were significantly decreased. Clinical staging scores were also reduced after splenectomy in patients who underwent splenectomy before hepatectomy.
  
  
  CONCLUSIONS
  Synchronous or metachronous splenectomy can increase the safety of hepatectomy in selected patients with HCC by reducing both the likelihood of bleeding complications and bilirubin overload.
authors.affiliation: Department of Hepatobiliary Pancreatic Surgery, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Sugawara
authors.forename: J
authors.initials: J
authors.lastname: Yamamoto
authors.forename: K
authors.initials: K
authors.lastname: Shimada
authors.forename: S
authors.initials: S
authors.lastname: Yamasaki
authors.forename: T
authors.initials: T
authors.lastname: Kosuge
authors.forename: T
authors.initials: T
authors.lastname: Takayama
authors.forename: M
authors.initials: M
authors.lastname: Makuuchi
mesh_terms: D000368:Aged; D001663:Bilirubin / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000150:complications / Q000401:mortality / Q000601:surgery*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D006971:Hypersplenism / Q000150:complications / Q000601:surgery*; D008113:Liver Neoplasms / Q000097:blood / Q000150:complications / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011184:Postoperative Period; D012189:Retrospective Studies; D013156:Splenectomy
chemical_list: D001663:Bilirubin