title: Synchronous splenectomy and hepatectomy in patients with hepatocellular carcinoma, hypersplenism and liver cirrhosis.
abstract: OBJECTIVE
  Hepatocellular carcinoma (HCC) mainly arises from underlying liver disease. Complicated liver cirrhosis and secondary hypersplenism are the most risk factors preventing surgical treatment of patients with HCC. The present study aimed at investigating the safety and long term outcome of patients with HCC and liver cirrhosis undergoing synchronous hepatectomy and splenectomy.
  
  
  METHODS
  The clinical data of 306 cases of patients with HCC and liver cirrhosis undergoing curative hepatectomy were reviewed. 18 cases underwent synchronous hepatectomy and splenectomy. The rest 288 cases of HCC with hepatectomy only were compared in aspects of clinicopathological and surgical variables and surgical outcomes.
  
  
  RESULTS
  Preoperative hemoglobin and platelet count were significantly lower in splenectomy than non-splenectomy group (p<0.01, respectively). Patients undergoing combined splenectomy and hepatectomy needed longer surgery time and hospital stay time, and transfused much more blood intraoperatively (p=0.07, 0.03, and 0.02), and also experienced more portal vein thrombosis (p<0.01). The level of hemoglobin and platelet increased after splenectomy and finally to normal level one month postoperatively. There was no statistical difference of overall and disease-free survival of patients in splenectomy and non-splenectomy groups (p>0.05).
  
  
  CONCLUSIONS
  With strict selection, patients with HCC and hypersplenism could undergo combined splenectomy and hepatectomy safely.
authors.forename: Rui
authors.initials: R
authors.lastname: Shi
authors.forename: Ya-Min
authors.initials: YM
authors.lastname: Zhang
authors.forename: Zhi-Jun
authors.initials: ZJ
authors.lastname: Zhu
authors.forename: Yong-Lin
authors.initials: YL
authors.lastname: Deng
authors.forename: Cheng
authors.initials: C
authors.lastname: Pan
authors.forename: Hong
authors.initials: H
authors.lastname: Zheng
authors.forename: Zhong-Yang
authors.initials: ZY
authors.lastname: Shen
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D006971:Hypersplenism / Q000097:blood / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000097:blood / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D008113:Liver Neoplasms / Q000097:blood / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013156:Splenectomy / Q000009:adverse effects / Q000401:mortality; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome