Laparoscopic splenectomy with peginterferon and ribavirin therapy for patients with hepatitis C virus cirrhosis and hypersplenism.

BACKGROUND

This study aimed to evaluate whether laparoscopic splenectomy (Lap-Sp) contributes to the completion and curability of combined peginterferon and ribavirin (peg-IFN + RIB) therapy for cirrhotic patients with pancytopenia due to hypersplenism.

METHODS

From December 2004 to September 2007, 21 patients underwent Lap-Sp before treatment with peg-IFN + RIB. All the patients were Child-Pugh class A or B with a mean platelet count of 5.7 x 10(4)/mm(3) and a mean leukocyte count of 2,830/mm(3). The hepatitis C virus (HCV) genotype was 1b for 18 patients and 2b for 3 patients. Of the 21 patients, 17 had a viral load exceeding 100 KIU/ml, and 4 had a load of less than 100 KIU/ml.

RESULTS

All the patients underwent Lap-Sp without severe complications. The average hospital stay was 12.7 days (range, 6-23 days). Platelet counts increased from a mean of 5.7 +/- 2.2 x 10(4)/mm(3) preoperatively to 19.6 +/- 7.6 x 10(4)/mm(3) postoperatively and remained above 7.0 x 10(4)/mm(3) during the subsequent peg-IFN + RIB therapy. The full course of therapy was completed for nine patients, with five obtaining a sustained virologic response and one obtaining a biologic response. The five patients who obtained a sustained virologic response had either HCV type 2b or 1b with a low viral load (<100 KIU). At this writing, treatment is ongoing for the remaining 12 patients.

CONCLUSIONS

Laparoscopic splenectomy allows patients with HCV cirrhosis and hypersplenism to receive full-dose peg-IFN + RIB therapy. Patients with HCV, genotype 2 or 1b and a low viral load, and hypersplenism may be good candidates for Lap-Sp.