Use of hepatectomy and splenectomy to treat hepatocellular carcinoma with cirrhotic hypersplenism.

BACKGROUND

The aim of this study was to compare the outcome after simultaneous hepatectomy and splenectomy with that after hepatectomy alone for hepatocellular carcinoma with associated hypersplenism.

METHODS

Two hundred and four patients with hepatocellular carcinoma and cirrhotic hypersplenism were divided non-randomly into two groups. Ninety-four underwent simultaneous hepatectomy and splenectomy and 110 underwent hepatectomy alone. White blood cell (WBC) and platelet counts, total serum bilirubin levels, immune function, incidence of complications and 5-year survival rates in the two groups were compared.

RESULTS

WBC and platelet counts, distribution of T cell subsets, and levels of bilirubin, interferon gamma and interleukin 2 were different between the two groups after operation. All patients who underwent hepatectomy and splenectomy but only 15.5 per cent of those who had hepatectomy alone completed adjuvant chemotherapy. The 5-year tumour-free survival rate was significantly higher after hepatectomy and splenectomy than after hepatectomy alone (37 versus 27.3 per cent; P = 0.003), although overall survival rates were similar.

CONCLUSION

Simultaneous hepatectomy and splenectomy was associated with improved 5-year tumour-free survival in patients with hepatocellular carcinoma and hypersplenism.