Effects of splenectomy in patients with cirrhosis undergoing hepatic resection for hepatocellular carcinoma.
OBJECTIVE
To study the effects of splenectomy in patients with cirrhosis undergoing hepatic resection for hepatocellular carcinoma.


METHODS
Twenty-six patients with HCC associated with cirrhosis were divided into hepatectomy with splenectomy group (splenectomy group, n=11) and hepatectomy without splenectomy group (non-splenectomy group, n=15). T lymphocyte subsets such as CD4, CD8, CD4/CD8, helper T (Th) lymphocyte cytokines such as interferon gamma (IFN-gamma), interleukin 2 (IL-2), interleukin 10 (IL-10) and white blood cell (WBC), platelet (PLT), total bilirubin (T-Bil) were measured and used as parameters to evaluate the effects of splenectomy.


RESULTS
There was no significant difference in CD4, CD8, CD4/CD8, IL2, IFN-gamma, IL10, WBC, PLT, T-Bil levels between two groups before surgery. Two months after operation, the levels of CD4 (41.2%+/-4.2% vs 34.7%+/-3.8%), CD4/CD8 (1.7+/-0.2 vs 1.0+/-0.2), IFN-gamma (102.3+/-15.9 pg/ml vs 86.5+/-14.8 pg/ml), IL-2(97.2+/-15.6 pg/ml vs 77.6+/-14.5 pg/ml) were increased and those of CD8 (25.6+/-3.9 vs 32.8%+/-4.1%), IL-10 (56.9+/-10.4 pg/ml vs 72.6+/-15.3 pg/ml) were decreased in splenectomy groups as compared with those in non-splenectomy group (P<0.05). WBC and PLT counts in the splenectomy group were 8.9+/-1.6 X 10(9) and 310+/-32 X 10(9), respectively, which were significantly higher than those in non-splenectomy group (3.7+/-1.4 X 10(9) and 104+/-41 X 10(9)) respectively on the 14th post-operative day. T-Bil concentration in the splenectomy group (24+/-7 micromol/L) was significantly lower than that in the non-splenectomy group (37+/-13 micromol/L) on the 7th post-operative day (P<0.05).


CONCLUSIONS
Splenectomy combined with hepatectomy for HCC associated with cirrhosis is helpful for the recovery of T-lymphocyte subsets and the maintenance of Th1/Th2 cytokine balance.
Cao
Zhi-Xin
ZX
Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China.
Chen
Xiao-Ping
XP
Wu
Zai-De
ZD
D000328:Adult; D016516:CD4-CD8 Ratio; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000601:surgery*; D016207:Cytokines / Q000097:blood; D005260:Female; D006498:Hepatectomy; D006801:Humans; D007958:Leukocyte Count; D008103:Liver Cirrhosis / Q000150:complications / Q000601:surgery*; D008113:Liver Neoplasms / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D013156:Splenectomy; D013921:Thrombocytopenia / Q000209:etiology / Q000601:surgery*
D016207:Cytokines