Synchronous laparoscopic hepatectomy combined with splenectomy for the treatment of hepatocellular carcinoma associated with cirrhotic portal hypertensive hypersplenism

Abstract

Objective To investigate the safety and clinical efficacies of synchronous laparoscopic hepatectomy combined with splenectomy for the treatment of hepatocellular carcinoma (HCC) associated with cirrhotic portal hypertensive hypersplenism. Methods The clinical data of 5 patients with HCC associated with cirrhotic portal hypertensive hypersplenism who were admitted to the Clinical Medical College of Yangzhou University between January 2015 and April 2015 were retrospectively analyzed. Five patients underwent synchronous laparoscopic hepatectomy combined with splenectomy and intraoperative autologous blood transfusion. The operation time, volume of intraoperative blood loss, time for diet intake, postoperative drainage tube removal time, duration of hospital stay and occurrence of complications were observed. Patients were followed up by outpatient examination and telephone interview till June 2015. Measurement data with normal distribution were presented as ±s. Results Of the 5 patients without conversion to open surgery, 3 patients underwent synchronous laparoscopic hepatectomy combined with splenectomy, 1 patient underwent laparoscopic hepatectomy+ splenectomy+ cholecystectomy and 1 patient underwent laparoscopic hepatectomy+ splenectomy+ devascularization. The operation time and volume of blood loss were (225±41)minutes and (221±81)mL. All the patients received intraoperative autologous blood transfusion without homologous blood transfusion. Two patients were complicated with abdominal effusion including 1 patient associated with pleural effusion, and symptoms of 2 patients disappeared after conservative treatment. All the patients took fluid diet at postoperative day 1 and out-of-bed activity at postoperative day 2, and drainage tubes were removed at postoperative day 3, with good recovery and without perioperative death. The duration of postoperative hospital stay was (7.8±0.8)days. All the 5 patients were followed up and survived well up to the end of follow-up. Conclusion Synchronous laparoscopic hepatectomy combined with splenectomy is safe and feasible for the treatment of HCC associated with cirrhotic portal hypertensive hypersplenism with an exact curative effect. Key words: Liver neoplasms; Hypersplenism; Splenectomy; Hepatectomy; Laparoscopy