Synchronous splenectomy and hepatectomy for patients with hepatocellular carcinoma and hypersplenism: A case-control study.
OBJECTIVE
To investigate whether the use of synchronous hepatectomy and splenectomy (HS) is more effective than hepatectomy alone (HA) for patients with hepatocellular carcinoma (HCC) and hypersplenism.


METHODS
From January 2007 to March 2013, 84 consecutive patients with HCC and hypersplenism who underwent synchronous hepatectomy and splenectomy in our center were compared with 84 well-matched patients from a pool of 268 patients who underwent hepatectomy alone. The short-term and long-term outcomes of the two groups were analyzed and compared.


RESULTS
The mean time to recurrence was 21.11±12.04 mo in the HS group and 11.23±8.73 mo in the HA group, and these values were significantly different (P=0.001). The 1-, 3-, 5-, and 7-year disease-free survival rates for the patients in the HS group and the HA group were 86.7%, 70.9%, 52.7%, and 45.9% and 88.1%, 59.4%, 43.3%, and 39.5%, respectively (P=0.008). Platelet and white blood cell counts in the HS group were significantly increased compared with the HA group one day, one week, one month and one year postoperatively (P<0.001). Splenectomy and micro-vascular invasion were significant independent prognostic factors for disease-free survival. Gender, tumor number, and recurrence were independent prognostic factors for overall survival.


CONCLUSIONS
Synchronous hepatectomy and hepatectomy potentially improves disease-free survival rates and alleviates hypersplenism without increasing the surgical risks for patients with HCC and hypersplenism.
Xiao-Yun Zhang, Chuan Li, Tian-Fu Wen, Lu-Nan Yan, Bo Li, Jia-Yin Yang, Wen-Tao Wang, Li Jiang, Department of Liver Surgery and Liver Transplantation Centre, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.
Xiao-Yun
XY
Zhang
Xiao-Yun Zhang, Chuan Li, Tian-Fu Wen, Lu-Nan Yan, Bo Li, Jia-Yin Yang, Wen-Tao Wang, Li Jiang, Department of Liver Surgery and Liver Transplantation Centre, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.
Chuan
C
Li
Xiao-Yun Zhang, Chuan Li, Tian-Fu Wen, Lu-Nan Yan, Bo Li, Jia-Yin Yang, Wen-Tao Wang, Li Jiang, Department of Liver Surgery and Liver Transplantation Centre, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.
Tian-Fu
TF
Wen
Xiao-Yun Zhang, Chuan Li, Tian-Fu Wen, Lu-Nan Yan, Bo Li, Jia-Yin Yang, Wen-Tao Wang, Li Jiang, Department of Liver Surgery and Liver Transplantation Centre, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.
Lu-Nan
LN
Yan
Xiao-Yun Zhang, Chuan Li, Tian-Fu Wen, Lu-Nan Yan, Bo Li, Jia-Yin Yang, Wen-Tao Wang, Li Jiang, Department of Liver Surgery and Liver Transplantation Centre, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.
Bo
B
Li
Xiao-Yun Zhang, Chuan Li, Tian-Fu Wen, Lu-Nan Yan, Bo Li, Jia-Yin Yang, Wen-Tao Wang, Li Jiang, Department of Liver Surgery and Liver Transplantation Centre, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.
Jia-Yin
JY
Yang
Xiao-Yun Zhang, Chuan Li, Tian-Fu Wen, Lu-Nan Yan, Bo Li, Jia-Yin Yang, Wen-Tao Wang, Li Jiang, Department of Liver Surgery and Liver Transplantation Centre, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.
Wen-Tao
WT
Wang
Xiao-Yun Zhang, Chuan Li, Tian-Fu Wen, Lu-Nan Yan, Bo Li, Jia-Yin Yang, Wen-Tao Wang, Li Jiang, Department of Liver Surgery and Liver Transplantation Centre, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.
Li
L
Jiang
D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016022:Case-Control Studies; D002681:China; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D006971:Hypersplenism / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000175:diagnosis / Q000378:metabolism / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011183:Postoperative Complications / Q000209:etiology; D016016:Proportional Hazards Models; D012307:Risk Factors; D013156:Splenectomy / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome
Case-control study; Hepatectomy; Hepatocellular carcinoma; Hypersplenism; Splenectomy