No abstract

A low immediate postoperative platelet count is an independent risk factor for hepatic insufficiency. Platelets can mediate liver regeneration in the cirrhotic liver.

BackgroundTreatments about small hepatocellular carcinoma (HCC) and hypersplenism associated with good hepatic reserve are not well established. The aim of this study was to investigate the outcome of synchronous hepatectomy and splenectomy for those patients.Study DesignSplenomegaly and hypersplenism were defined as a pathological spleen. Seven hundred fifty-six patients with small HCC (381 with a pathological spleen, 375 without a pathological spleen) were divided into three groups. One hundred ten of 381 patients underwent synchronous hepatectomy and splenectomy (group A), 271 of 381 patients underwent hepatectomy alone (Group B) and 375 patients without pathological spleen underwent hepatectomy alone (Group C).The influence of pathological spleen, outcome of different treatments and systemic inflammatory response indexes were analyzed.ResultsBoth overall survival (OS, P=0.023) and disease-free survival (DFS, P=0.020) were significantly increased in group C compared to group B. A pathological spleen was a significant independent prognostic factor for OS and DFS among those two groups. In addition, OS (P=0.025) and DFS (P=0.004) were increased in the group A compared to group B. Splenectomy and neutrophil to lymphocyte ratio changes (ΔNLR) were significant independent prognostic factors of the prognosis for patients in groups A and B.ConclusionsA Pathological spleen influences the outcome of HCC patients. Synchronous hepatectomy and splenectomy should be performed among patients with small HCC and a pathological spleen. ΔNLR can predict the prognosis of these patients.

This meta-analysis shows that TNFA-308G/A, TNFA-238G/A and TNFA-863C/A polymorphisms may be associated with HCC among Asians. TNFA-857C/T and TNFA-1031T/C polymorphisms were not detected to be related to the risk for HCC.

The aim of this study was to evaluate different surgical therapies for hepatic alveolar echinococcosis in different clinical stages.We analyze the clinical data of 115 patients who received surgical treatment in West China Hospital from January 2004 to June 2016. Among these patients, 77 cases underwent radical hepatic resection (group A, n = 77); 17 cases underwent palliative resection (group B, n = 17), and 21 cases underwent liver transplantation (group C, n = 21) with 12 cases of orthotopic liver transplantation and 9 cases of liver autotransplantation.The postoperative complication rate of radical hepatic resection group was 13.0% (10/77), which is statistically significant (P < .05) than the rate of palliative resection group 29.4% (5/17) or liver transplantation group 23.8% (5/21). The follow-up period ranged from 1 to 72 months. The overall median survival rate of radical resection was 72/77, higher than the rate of palliative group (12/17) or transplantation group (17/21), which was also statistically significant (P < .01).In our study, we believe in that all stages of hepatic alveolar echinococcosis should take active surgical interventions, and radical hepatic resection should be considered as the first-choice treatment for early stage of alveolar echinococcosis, while palliative surgery is still helpful to relieve symptoms and improve the life quality for advanced patients. Liver transplantation might also be an alternative option for the late-stage hepatic alveolar echinococcosis.