Two Cases of Splenectomy Combined with Hepatectomy for Patients with Insufficient Future Liver Remnant Volume

Abstract

The usefulness of splenectomy combined with hepatectomy for patients without liver cirrhosis (LC) have been equivocal, even though splenectomy for hepatocellular carcinoma (HCC) patients with portal hypertension could improve the surgical safety. We performed splenectomy with hepatectomy in one case of HCC patient with LC and one case of intrahepatic cholangiocarcinoma (ICC) patient without LC. Therefore, we will report the cases. Case 1: A 77-year-old woman with LC underwent hepatectomy for HCC in liver segment 5 with portal vein (PV) tumor thrombosis. Her blood test showed platelets count of 148,000 /μl, ICG 15-minute value of 18.3%, ICG-K value of 0.110. Right lobectomy was planned, and the future liver remnant volume (FLRV) was 336 ml (36.1%) / remnant liver ICG-K value was 0.039. Intraoperative PV pressure slightly increased from 10 to 11 mmHg after hepatectomy, and decreased to 9 mmHg after splenectomy. She was discharged 18 days after the operation without any major complications. Case 2: A 46-year-old man without LC underwent hepatectomy for ICC. His blood test showed platelets count of 248,000 /μl, ICG 15-minute value of 12.9%, ICG-K value of 0.152. Extended right lobectomy was planned and the FLRV was 736 ml (39.3%) / remnant liver ICG-K value was 0.059. Intraoperative PV pressure increased from 20 to 25 mmHg after hepatectomy, and decreased to 20 mmHg after splenectomy. He was discharged 31 days after the operation without any major complications, but intractable ascites. Conclusion: Splenectomy combined with hepatectomy for patients without LC may improve the surgical safety.