Impact of Splenic Volume and Splenectomy on Prognosis of Hepatocellular Carcinoma Within Milan Criteria After Curative Hepatectomy

Takeishi, Kazuki; Kawanaka, Hirofumi; Itoh, Shinji; Harimoto, Norifumi; Ikegami, Toru; Yoshizumi, Tomoharu; Shirabe, Ken; Maehara, Yoshihiko

doi:10.1007/s00268-017-4232-z

Cited by 24 publications

(25 citation statements)

References 48 publications

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“…Whether gastric cancer patients with DROSD have also experienced the function disorder of immunity, which lead to the patient having short- and long-term differences still requires further experimental verification. Second, it has been reported that splenic volume increase is a surrogate marker of inflammation cells accumulation and associated with worse long-term survival ( 27 , 28 ). As mentioned in the previous literature, the reduction of spleen density in acute severe pancreatitis rats was related to the increase of spleen volume ( 7 ).…”

Section: Discussionmentioning

confidence: 99%

Diffuse Reduction of Spleen Density Is an Independent Predictor of Post-Operative Outcomes After Curative Gastrectomy in Gastric Cancer: A Multi-Center Study

et al. 2020

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Objectives: The present study aimed to explore the association between spleen density and post-operative outcomes of patients after curative gastrectomy. Methods: From June 2014 to December 2015, we conducted a retrospective study to analyze pertinent clinical data from gastric cancer patients who underwent gastrectomy at the First and the Second Affiliated Hospital of Wenzhou Medical University. Spleen density was determined via computed tomography scans. Univariate and multivariate analyses were performed to determine the risk factors associated with post-operative outcomes after gastric cancer surgery. Results: Three hundred and ninety five patients were included, of whom 98 (24.8%) were defined as having a diffuse reduction of spleen density based on diagnostic cutoff values (spleen density ≤ 43.89 HU). Multivariate analysis revealed diffuse reduction of spleen density as an independent risk factor for post-operative complications and long-term overall survival. Conclusions: Spleen density can predict severe postoperative complications and long-term overall survival in gastric cancer patients. As an imaging evaluation method, spleen density is a novel tool can be used in clinical as a prognostic predictor for patients with gastric cancer.

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Section: Discussionmentioning

confidence: 99%

Diffuse Reduction of Spleen Density Is an Independent Predictor of Post-Operative Outcomes After Curative Gastrectomy in Gastric Cancer: A Multi-Center Study

et al. 2020

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“…While hypersplenism was associated with HCC recurrence and poor outcome, splenectomy for hypersplenism improved outcomes among patients undergoing curative resection for HCC. [13,16] Similarly, using a murine orthotopic model, Li and colleagues had demonstrated that splenectomy prevented tumor growth and improved immune responses of tumor-bearing hosts by decreasing myeloidderived suppressor cells, and increasing natural killer (NK) cells and NK T cells in liver tumor tissues. [26] Similarly, Liu et al demonstrated in a murine model that splenectomy accelerated liver regeneration after partial hepatectomy of HCC by improvement of the tight junction formation which helped in establishment of hepatocyte polarity via Par 3-aPKC.…”

Section: Discussionmentioning

confidence: 99%

“…[11] In fact, high splenic volume has been independently associated with post-hepatectomy HCC recurrence and overall survival. [13] Of note, recent studies have demonstrated that hypersplenism secondary to liver cirrhosis and portal hypertension was an independent risk factor associated with HCC development. [14][15][16] The association between hypersplenism and HCC development might be multifactorial but also partially as a result of thrombocytopenia, since thrombocytopenia has also associated with an increased risk for HCC development.…”

Section: Introductionmentioning

confidence: 99%

Splenectomy May Decrease the Risk of Hepatocellular Carcinoma in Patients with Liver Cirrhosis: A Multi-institutional Cohort Study

Zhang

Liu

et al. 2020

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BackgroundHypersplenism is a common consequence of liver cirrhosis and a risk factor of hepatocellular carcinoma (HCC) development. The objective of the current study was to identify whether splenectomy for treatment of hypersplenism has any impact on risk of HCC. MethodsPatients who underwent splenectomy for hypersplenism secondary to liver cirrhosis and portal hypertension between 2008 and 2012 were included from seven University Hospitals in China, whereas patients receiving medication treatments for liver cirrhosis and portal hypertension (non-splenectomy) at this time period were also included as control. ResultsA total of 871 patients with liver cirrhosis and hypertension were included synchronously from 7 tertiary hospitals. Among them, 407 patients had a history of splenectomy for hypersplenism, whereas 464 patients who received medical treatment but not splenectomy (non-splenectomy group). The cumulative incidence of HCC development at 1, 3, 5 and 7 years were 1%, 6%, 11% and 16% in splenectomy group, and 2%, 10%, 17% and 24% in non-splenectomy group in the unadjusted cohort (Breslow test = 7.7, p=0.005). Consistently, in the matched cohort, the cumulative rates of HCC diagnosis at 1, 3, 5 and 7 years were 1%, 6%, 7% and 15% in splenectomy group, and 1%, 6%, 15% and 23% in non-splenectomy group (Breslow test = 4.9, p=0.028). On multivariable analysis, splenectomy was independently associated with decreased risk of HCC development (HR 0.55, 95% CI, 0.32-0.95, p=0.031). ConclusionSplenectomy for treatment of hypersplenism may decrease the risk of HCC development.

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“…BRTO increases hepatopetal portal flow and improves liver function of patients with reserve liver capacity [21]. High splenic volume is an independent predictor of the recurrence of posthepatectomy HCC and overall survival [22]. Thus, splenectomy reduces portal pressure in patients with PH and improves liver function [23].…”

Section: Discussionmentioning

confidence: 99%

Multimodal approach to portal hypertension and gastric varices before hepatic resection for hepatocellular carcinoma: a case report

et al. 2020

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Background: Liver cirrhosis occurs in approximately 80-90% of patients with hepatocellular carcinoma (HCC), and hepatic resection may be dangerous because of well-documented liver cirrhosis, which may be accompanied by portal hypertension (PH). Here we report a patient with advanced HCC with gastric varices and PH who experienced a good clinical course after undergoing balloon-occluded retrograde transvenous obliteration (BRTO), percutaneous transhepatic portal vein embolization (PTPE), hand-assisted laparoscopic (HALS) splenectomy, and right lobectomy of the liver. Case presentation: A 72-year-old man had two HCCs with gastric varices. CT revealed one tumor (4.5 cm) located in segment 7, involving the right hepatic vein, adjacent to the middle hepatic vein. Another tumor (2.7 cm) was located in segment 6. He first underwent BRTO for gastric varices and PTPE for planned right lobectomy of the liver. To reduce PH, HALS splenectomy was performed, and uncomplicated right lobectomy of the liver was performed 10 weeks after the first visit. He has remained free of recurrence for at least 1 year. Conclusions: Our patient underwent uncomplicated BRTO, PTPE, HALS splenectomy, and right lobectomy of the liver for advanced HCC with PH. Controlling portal pressure is important when hepatic resection is required to treat HCC with PH.

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Impact of Splenic Volume and Splenectomy on Prognosis of Hepatocellular Carcinoma Within Milan Criteria After Curative Hepatectomy

Cited by 24 publications

References 48 publications

Diffuse Reduction of Spleen Density Is an Independent Predictor of Post-Operative Outcomes After Curative Gastrectomy in Gastric Cancer: A Multi-Center Study

Diffuse Reduction of Spleen Density Is an Independent Predictor of Post-Operative Outcomes After Curative Gastrectomy in Gastric Cancer: A Multi-Center Study

Splenectomy May Decrease the Risk of Hepatocellular Carcinoma in Patients with Liver Cirrhosis: A Multi-institutional Cohort Study

Multimodal approach to portal hypertension and gastric varices before hepatic resection for hepatocellular carcinoma: a case report

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