Splenectomy in patients with hepatocellular carcinoma and hypersplenism

Background: Hypersplenism secondary to portal hypertension is common in hepatocellular carcinoma (HCC), but surgeons still face the unresolved problem of how to manage HCC patients with hypersplenism. Study Design: The records of 48 patients with HCC and hypersplenism were retrospectively examined and postoperative changes in platelet counts, serum total bilirubin levels, and clinical staging scores were analyzed to evaluate the clinical value of combined splenectomy and liver resection. Hepatectomy and splenectomy were performed as a two-stage operation in 13 patients and synchronously in 35. Results: Postoperative platelet counts were significantly increased, and serum total bilirubin levels were significantly decreased. Clinical staging scores were also reduced after splenectomy in patients who underwent splenectomy before hepatectomy. Conclusions: Synchronous or metachronous splenectomy can increase the safety of hepatectomy in selected patients with HCC by reducing both the likelihood of bleeding complications and bilirubin overload. (J Am Coll Surg 2000;190:446-450. (C) 2000 by the American College of Surgeons).