title: Splenectomy in chronic hepatic disorders: portal vein thrombosis and improvement of liver function.
abstract: BACKGROUND
  Splenectomy is gaining increasing importance for cirrhotic patients with hypersplenism. However, its safety and efficacy for patients with chronic liver disease remain unclear.
  
  
  METHODS
  We retrospectively examined the medical records of 38 consecutive cirrhotic patients who underwent splenectomy or simultaneous hepatectomy and splenectomy for hepatocellular carcinoma.
  
  
  RESULTS
  White blood cell and platelet counts significantly increased 3 months after splenectomy. Serum levels of total bilirubin and prothrombin time significantly improved 1 year after splenectomy. Interferon therapy was administered to 25 patients after splenectomy. A sustained viral response was achieved in 8 patients (42%). The total incidence of portal or splenic vein thrombosis (PSVT) detected by postoperative dynamic computed tomography was 13/38 (34.2%). Multivariate analysis revealed preoperative spleen volume (SV) to be the sole independent predictor of postoperative PSVT. Receiver-operator characteristic curve analysis showed that a cut-off SV of 450 ml corresponded to a sensitivity of 85% and a specificity of 56%.
  
  
  CONCLUSIONS
  Splenectomy improved the liver function and facilitated effective interferon therapy in cirrhotic patients with hypersplenism, although preoperative SV was frequently associated with postoperative PSVT.
authors.affiliation: Department of Gastroenterological Surgery, Hiroshima University Hospital, Japan.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Ushitora
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Tashiro
authors.forename: Shoichi
authors.initials: S
authors.lastname: Takahashi
authors.forename: Hironobu
authors.initials: H
authors.lastname: Amano
authors.forename: Akihiko
authors.initials: A
authors.lastname: Oshita
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Kobayashi
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Chayama
authors.forename: Hideki
authors.initials: H
authors.lastname: Ohdan
mesh_terms: D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use; D001663:Bilirubin / Q000097:blood; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects; D006801:Humans; D006971:Hypersplenism / Q000473:pathology / Q000601:surgery*; D007372:Interferons / Q000627:therapeutic use; D007958:Leukocyte Count; D008099:Liver / Q000503:physiopathology*; D008103:Liver Cirrhosis / Q000503:physiopathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009929:Organ Size; D010976:Platelet Count; D011169:Portal Vein / Q000503:physiopathology*; D011517:Prothrombin Time; D012372:ROC Curve; D012189:Retrospective Studies; D013154:Spleen / Q000473:pathology; D013156:Splenectomy / Q000009:adverse effects; D013162:Splenic Vein / Q000503:physiopathology*; D020246:Venous Thrombosis / Q000209:etiology* / Q000503:physiopathology
chemical_list: D000998:Antiviral Agents; D007372:Interferons; D001663:Bilirubin