Role of splenectomy in hepatic resection for hepatocellular carcinoma associated with severe cirrhosis and hypersplenism

The incidence of hepatocellular carcinoma (HCC) associated with severe cirr hosis has been increasing due to better management of chronic liver disease . This study prospectively aimed to elucidate whether splenectomy is benefi cial or detrimental when performed simultaneously with hepatic resection in patients with HCC and hypersplenism due to severe cirrhosis. Splenectomy a nd subsequent partial hepatectomy were concomitantly performed on 26 patien ts with Child-Turcotte class B (n = 17) or C (n = 9) cirrhosis, HCC and hyp ersplenism. Portal pressure was measured before and after splenectomy in 21 cases. Endothelin-l (ET-1) levels in splenic venous blood were estimated i n eight cases. The splenectomy reduced portal venous pressure by 20%. The E T-1 level in splenic venous blood was significantly higher than that in sys temic blood indicating the release of ET-1 from the spleen into the portal circulation. Operative morbidity and mortality rates were 23.1 and 11.5%. C hild's class C was improved to class B or A in half of the patients. The 1- , 3-, and 5-year survival rates were 61.5, 42.3 and 16.5%. These results we re compared with those of 36 patients with Child's class B (n=29) or class C (n=7) cirrhosis and HCC in whom concomitant splenectomy had not been perf ormed because of weak or no hypersplenism. The extent of hypersplenism and hepatic dysfunction was more severe and the estimated blood loss during sur gery was larger in the splenectomy group. Despite such background differenc es, there were no significant differences between the two groups in postope rative morbidity and mortality rates, causes of late death, and long-term s urvival rate. Concomitant splenectomy during hepatic resection seems to be beneficial in the treatment of HCC and hypersplenism associated with severe cirrhosis. (C) 1999 Elsevier Science Ireland Ltd. All rights reserved.