Laparoscopic splenectomy may be a superior supportive intervention for cirrhotic patients with hypersplenism.
OBJECTIVE
To evaluate and compare laparoscopic splenectomy and partial splenic embolization as supportive intervention for cirrhotic patients with hypersplenism to overcome peripheral cytopenia before the initiation of and during interferon therapy or anticancer therapy for hepatocellular carcinoma.


METHODS
Between December 2000 and April 2008, 43 Japanese cirrhotic patients with hypersplenism underwent either laparoscopic splenectomy or partial splenic embolization as a supportive intervention to facilitate the initiation and completion of either interferon therapy or anticancer therapy for hepatocellular carcinoma. We reviewed the peri- and post-intervention outcomes and details of the subsequent planned main therapies. For interferon therapy, the rate of completion, the rate of treatment cessation and virological responses were evaluated. Anti-cancer therapies for hepatocellular carcinoma included liver resection, ablation therapy, intra-arterial chemotherapy, and transarterial chemoembolization.


RESULTS
All patients tolerated the operations well with no significant complications. The platelet count was significantly higher in the laparoscopic splenectomy group than in the partial splenic embolization group at 1 and 2 weeks after the intervention. Interferon therapy was stopped in two patients in the partial splenic embolization group due to recurrent thrombocytopenia whereas all patients in the laparoscopic splenectomy group completed interferon therapy. The planned anticancer therapies were performed in all patients, and were completed in all patients without any problems or major complications.


CONCLUSIONS
Laparoscopic splenectomy may be superior to partial splenic embolization as a supportive intervention for cirrhotic patients with hypersplenism. Future prospective, randomized controlled patient studies are required to confirm these findings.
Tomikawa
Morimasa
M
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. mtomikaw@surg2.med.kyushu-u.ac.jp
Akahoshi
Tomohiko
T
Sugimachi
Keishi
K
Ikeda
Yasuharu
Y
Yoshida
Kisaku
K
Tanabe
Yuichi
Y
Kawanaka
Hirofumi
H
Takenaka
Kenji
K
Hashizume
Makoto
M
Maehara
Yoshihiko
Y
D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000628:therapy*; D017115:Catheter Ablation; D004621:Embolization, Therapeutic / Q000009:adverse effects; D005260:Female; D006498:Hepatectomy; D006801:Humans; D006971:Hypersplenism / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D007372:Interferons / Q000627:therapeutic use; D007564:Japan; D010535:Laparoscopy / Q000009:adverse effects; D007970:Leukopenia / Q000209:etiology / Q000517:prevention & control; D008103:Liver Cirrhosis / Q000150:complications / Q000628:therapy*; D008113:Liver Neoplasms / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D013156:Splenectomy / Q000009:adverse effects / Q000379:methods*; D013921:Thrombocytopenia / Q000209:etiology / Q000517:prevention & control; D013997:Time Factors; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D007372:Interferons