Case Control Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 28, 2015; 21(8): 2358-2366
Published online Feb 28, 2015. doi: 10.3748/wjg.v21.i8.2358
Synchronous splenectomy and hepatectomy for patients with hepatocellular carcinoma and hypersplenism: A case-control study
Xiao-Yun Zhang, Chuan Li, Tian-Fu Wen, Lu-Nan Yan, Bo Li, Jia-Yin Yang, Wen-Tao Wang, Li Jiang
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
Author contributions: Zhang XY and Wen TF proposed the study; Zhang XY, Li C, and Jiang L performed the research; Zhang XY, Li C, and Jiang L collected and analyzed the data; Zhang XY wrote the first draft; Wen TF reviewed the paper; all authors contributed to the design and interpretation of the study and to the revision of the manuscript.
Supported by Grants from National Science and Technology Major Project of China, No. 2012ZX10002-016 and No. 2012ZX10002-017.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Tian-Fu Wen, Professor, Department of Liver Surgery and Liver Transplantation Centre, West China Hospital of Sichuan University, No. 37 Guoxuexiang, Chengdu 610041, Sichuan Province, China. cdwentianfu@sohu.com
Telephone: +86-28-85422871 Fax: +86-28-85422396
Received: August 21, 2014
Peer-review started: August 23, 2014
First decision: September 15, 2014
Revised: October 7, 2014
Accepted: November 11, 2014
Article in press: November 11, 2014
Published online: February 28, 2015
Processing time: 191 Days and 0.4 Hours
Abstract

AIM: 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.

CONCLUSION: Synchronous hepatectomy and hepatectomy potentially improves disease-free survival rates and alleviates hypersplenism without increasing the surgical risks for patients with HCC and hypersplenism.

Keywords: Hepatocellular carcinoma; Hypersplenism; Splenectomy; Hepatectomy; Case-control study

Core tip: The optimal approach for treating patients suffering from hepatocellular carcinoma (HCC) and hypersplenism is not well established. In the present study, synchronous hepatectomy and hepatectomy improved disease-free survival rates and alleviated hypersplenism without increasing the surgical risk for patients with HCC and hypersplenism.