Surgical treatment for hepatocellular carcinoma and secondary hypersplenism.
BACKGROUND
Hepatocellular carcinoma (HCC) is a common disease with high mortality and serious effect on the life quality of patients. Operation is still the most effective treatment. Currently, in China, patients with HCC are often complicated by hepatitis B related liver cirrhosis and secondary hypersplenism. This study was undertaken to evaluate the effect and indications of synchronous hepatectomy and splenectomy for HCC patients with hypersplenism.


METHODS
The clinical records and treating processes of 24 patients with HCC and hypersplenism during the period of January 1991 to July 2004 were analyzed retrospectively.


RESULTS
Sixteen patients underwent hepatectomy and splenectomy, including extensive devascularizasion around the cardia (9 patients). Seven patients were treated with microwave ablation and splenectomy plus extensive esophagogastric devascularization. One patient underwent hepatectomy combined with microwave ablation and splenectomy plus extensive esophagogastric devascularization. There were no deaths during the operation. During the first week after operation, the symptoms of hypersplenism disappeared and the platelet (Plt) and white blood cell (WBC) counts were significantly elevated (Plt: 247 X 10(9)/L vs. 45.9 X 10(9)/L, WBC: 13.0 X 10(9)/L vs. 3.3 X 10(9)/L, P<0.01).


CONCLUSIONS
Synchronous splenectomy can increase the safety of hepatectomy in selected patients with HCC and secondary hypersplenism by reducing bleeding complications. Splenectomy enhances patients' immunity against tumor in a long period as well.
Wang
Qian
Q
Department of Hepatobiliary Surgery, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, China. wangqian00@hotmail.com
Sun
Kai
K
Li
Xiang-Hong
XH
Peng
Bao-Gang
BG
Liang
Li-Jian
LJ
D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000601:surgery*; D006498:Hepatectomy; D006801:Humans; D006971:Hypersplenism / Q000150:complications / Q000601:surgery*; D008113:Liver Neoplasms / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged