title: Appraisal of concomitant splenectomy in liver resection for hepatocellular carcinoma in cirrhotic patients with hypersplenic thrombocytopenia.
abstract: BACKGROUND
  Liver resection usually is not recommended for hepatocellular carcinoma (HCC) in cirrhotic patients with portal hypertension. The role of concomitant splenectomy in liver resection for HCC in cirrhotic patients with hypersplenic thrombocytopenia (HT) resulting from portal hypertension remains undefined.
  
  
  METHODS
  Among 526 cirrhotic patients who underwent liver resection for HCC, 41 underwent a concomitant splenectomy (Sp group) because of HT (platelet count </=80 x 10(3)/mm(3)). The patients' backgrounds, pathologic characteristics of HCC, and short- and long-term results after liver resection of Sp group were compared with those of the other 485 cirrhotic patients who did not undergo splenectomy (non-Sp group).
  
  
  RESULTS
  Compared to the non-Sp group, the liver function was worse, the tumor size was smaller, the liver resection extent was narrower, and tumor stages were earlier in the Sp group. The postoperative morbidity, mortality, hospital stay, and hospital costs were not significantly different between the groups. The disease-free survival rate of the Sp group was better than that of non-Sp group, but the actuarial survival rates of both groups were similar. After stratification with UICC-TNM stages, there were no significant differences regarding the disease-free and actuarial survival rates in each stage.
  
  
  CONCLUSIONS
  Concomitant splenectomy extends the indication of liver resection for HCC in cirrhotic patients with portal hypertension. It is justified in selected cirrhotic patients with HCC and HT.
authors.affiliation: Department of Surgery, Taichung Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Cheng-Chung
authors.initials: CC
authors.lastname: Wu
authors.forename: Shao-Bin
authors.initials: SB
authors.lastname: Cheng
authors.forename: Wai-Meng
authors.initials: WM
authors.lastname: Ho
authors.forename: Jung-Ta
authors.initials: JT
authors.lastname: Chen
authors.forename: Dah-Cherng
authors.initials: DC
authors.lastname: Yeh
authors.forename: Tse-Jia
authors.initials: TJ
authors.lastname: Liu
authors.forename: Fang-Ku
authors.initials: FK
authors.lastname: P'eng
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000209:etiology / Q000601:surgery*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D006971:Hypersplenism / Q000150:complications / Q000601:surgery*; D006975:Hypertension, Portal / Q000209:etiology; D008103:Liver Cirrhosis / Q000150:complications / Q000601:surgery; D008113:Liver Neoplasms / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D013156:Splenectomy; D016019:Survival Analysis; D013921:Thrombocytopenia / Q000209:etiology; D016896:Treatment Outcome