Appraisal of simultaneous laparoscopic splenectomy and hepatic resection in the treatment of hepatocellular carcinoma with hypersplenic thrombocytopenia.

Abstract

The management of hepatocellular carcinoma with hypersplenic thrombocytopenia remains controversial, because of the high surgical morbidity and mortality. Splenectomy has been reported to be useful for patients with hypersplenic thrombocytopenia, but the timing and route of splenectomy and hepatic resection remains unclear. This report evaluated the efficacy of laparoscopic surgery for simultaneous splenectomy and hepatic resection in the treatment of hepatocellular carcinoma with hypersplenic thrombocytopenia. Among 65 patients with hypersplenic thrombocytopenia who underwent hepatic resection for hepatocellular carcinoma, 20 patients underwent simultaneous splenectomy and hepatic resection. Initially, ten patients underwent the procedure by conventional laparotomy (open group) and ten patients underwent by laparoscopy (laparoscopic group). The clinicopathological results from the two groups were compared retrospectively. The blood loss in the laparoscopic group was significantly less and the postoperative morbidity rate in the laparoscopic group was lower than that in the open group. The duration of the postoperative hospital stay in the laparoscopic group was significantly shorter and rate of patients administered interferon in the laparoscopic group was significantly higher than that in open group. Simultaneous splenectomy and hepatic resection under laparoscopy is a safe and useful in the treatment of hepatocellular carcinoma with hypersplenic thrombocytopenia.