Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Sep 27, 2022; 14(9): 930-939
Published online Sep 27, 2022. doi: 10.4240/wjgs.v14.i9.930
Liver transplantation with simultaneous splenectomy increases risk of cancer development and mortality in hepatocellular carcinoma patients
Hsiu-Lung Fan, Chung-Bao Hsieh, Shih-Ming Kuo, Teng-Wei Chen
Hsiu-Lung Fan, Chung-Bao Hsieh, Teng-Wei Chen, Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11409, Taiwan
Shih-Ming Kuo, Division of Pediatric Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11409, Taiwan
Author contributions: Fan HL participated in data analysis and the writing of the paper; Hsieh CB participated in research design; Kuo SM participated in research design; Chen TW participated in data interpretation and revision of the paper
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Tri-Service General Hospital, No. 2-108-05-127.
Informed consent statement: Informed consent was not required by the guidance of the institutional review board because this study was a retrospective study and the analysis used clinical data anonymously.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Teng-Wei Chen, MD, Associate Professor, Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec 2, Chen-Kung Road, Neihu 114, Taipei 11409, Taiwan. tengweichen@yahoo.com.tw
Received: April 13, 2022
Peer-review started: April 13, 2022
First decision: May 9, 2022
Revised: May 24, 2022
Accepted: August 24, 2022
Article in press: August 24, 2022
Published online: September 27, 2022
Processing time: 161 Days and 23.3 Hours
ARTICLE HIGHLIGHTS
Research background

Patients undergoing splenectomy were more likely to develop cancer than patients not undergoing splenectomy. There are a number of indications for simultaneous splenectomy in liver transplantation (LT) recipients.

Research motivation

The hypothesis is that simultaneous splenectomy has bad outcomes on cancer and mortality in LT recipients.

Research objectives

The purpose of this study was to compare the outcomes of hepatocellular carcinoma (HCC) recurrence and de novo malignancy development between HCC patients who underwent LT with and without simultaneous splenectomy.

Research methods

Of 120 patients with HCC who received LT with (n = 35) and without (n = 85) simultaneous splenectomy were analyzed by Cox regression analysis, Kaplan–Meier survival curves and log-rank tests.

Research results

Splenectomy and age were both positive independent factors for prediction of cancer development. Splenectomy and hypertension were positive independent factors for prediction of mortality. The splenectomy group had a significantly worse cancer-free survival and overall survival curve compared to the nonsplenectomy group.

Research conclusions

Simultaneous splenectomy should be avoided in patients with HCC undergoing LT.

Research perspectives

Splenic artery ligation is often considered, instead of splenectomy, for achieving the goal of modulation of portal inflow. The direction of the future research is the comparison on cancer outcome between splenectomy and splenic artery ligation.