title: Hepatectomy for hepatocellular carcinoma in patients with severe thrombocytopenia.
abstract: OBJECTIVE
  Hepatic resection for hepatocellular carcinoma (HCC) is risky for cirrhotic patients with severe thrombocytopenia.
  
  
  METHODS
  Among 23 patients with histologically proven cirrhosis who underwent hepatic resection for HCC at our hospital since 2006, 7 had severe thrombocytopenia (platelet count <5×104/mm3). The clinical background and surgical outcomes of these 7 patients were retrospectively evaluated and compared to those of the 16 cirrhotic patients without severe thrombocytopenia.
  
  
  RESULTS
  All 7 patients had hepatitis C virus-related liver cirrhosis. The median preoperative platelet count was 4.3×104/mm3 (range, 3.9-4.9×104/mm3) and the median operative time and intraoperative bleeding were 77min and 193cc, respectively. Postoperative complications were observed in 4 patients (57%) and all were managed conservatively. Four patients received an intraoperative platelet-rich transfusion, but this had no beneficial effect on intraoperative bleeding or postoperative changes in platelet counts. The cirrhotic patients with severe thrombocytopenia were significantly younger and had a significantly shorter operative time compared to those without severe thrombocytopenia. There were no other differences between the groups.
  
  
  CONCLUSIONS
  Our results suggest that the indication for hepatectomy in cirrhotic patients should not be based on platelet counts alone. However, we note that the younger age and shorter operative time for the patients with severe thrombocytopenia might have contributed to the safety of hepatectomy.
authors.affiliation: Department of Surgery, Ishikiriseiki Hospital, Higashiosaka, Japan. m8827074@msic.med.osaka-cu.ac.jp
authors.forename: Shogo
authors.initials: S
authors.lastname: Tanaka
authors.forename: Kanji
authors.initials: K
authors.lastname: Ishihara
authors.forename: Chie
authors.initials: C
authors.lastname: Watanabe
authors.forename: Kohichi
authors.initials: K
authors.lastname: Ohno
authors.forename: Takatsugu
authors.initials: T
authors.lastname: Yamamoto
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000601:surgery*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000097:blood / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017713:Platelet Transfusion; D013921:Thrombocytopenia / Q000150:complications*