Splenectomy in Chronic Hepatic Disorders: Portal Vein Thrombosis and Improvement of Liver Function

Abstract

Background: Splenectomy is gaining increasing importance for cirrhotic patients with hypersplenism. However, its safety and efficacy for patients with chronic liver disease remain unclear. Methods: We retrospectively examined the medical records of 38 consecutive cirrhotic patients who underwent splenectomy or simultaneous hepatectomy and splenectomy for hepatocellular carcinoma. Results: White blood cell and platelet counts significantly increased 3 months after splenectomy. Serum levels of total bilirubin and prothrombin time significantly improved 1 year after splenectomy. Interferon therapy was administered to 25 patients after splenectomy. A sustained viral response was achieved in 8 patients (42%). The total incidence of portal or splenic vein thrombosis (PSVT) detected by postoperative dynamic computed tomography was 13/38 (34.2%). Multivariate analysis revealed preoperative spleen volume (SV) to be the sole independent predictor of postoperative PSVT. Receiver-operator characteristic curve analysis showed that a cut-off SV of 450 ml corresponded to a sensitivity of 85% and a specificity of 56%. Conclusions: Splenectomy improved the liver function and facilitated effective interferon therapy in cirrhotic patients with hypersplenism, although preoperative SV was frequently associated with postoperative PSVT.

Splenectomy attenuates murine liver fibrosis with hypersplenism stimulating hepatic accumulation of Ly-6Clo macrophages

“…Liver function parameters have been often improved after splenectomy, in addition to the amelioration of thrombocytopenia in several clinical reports [3][4][5][6]; however the underlying mechanism remains unclear. To investigate the mechanism, an appropriate animal model resembling the clinical situation is required.…”

“…Meanwhile, splenectomy has been performed as a palliative surgical treatment to attenuate hypersplenism [1,2]. Recently, it has been reported that liver function parameters improved after splenectomy, in addition to the amelioration of thrombocytopenia in several clinical settings [3][4][5][6]. However, the mechanism underlying such a phenomenon remains unclear, and the significant role of platelets in liver fibrosis has been emphasized in some reports [7,8].…”

Laparoscopic Splenectomy for the Elderly Liver Cirrhotic Patients With Hypersplenism

“…8–10 Since it was first reported by Delaitre in 1991, 11 laparoscopic splenectomy (LS) has demonstrated distinct advantages compared with open splenectomy (OS), including shorter hospital stays, less blood loss, reduced costs, and better cosmetic outcomes; since then, it has been recommended as the standard procedure for benign hematological diseases, particularly for chronic immune thrombocytopenia (ITP). 12 Recently, a number of studies have clarified the feasiBILity, safety, and effectiveness of LS for hypersplenism caused by liver cirrhosis, suggesting that patients will benefit more in terms of short- and long-term surgical outcomes compared with OS.…”

Hepatectomy combined with microwave ablation of the spleen for treatment of hepatocellular carcinoma complicated with splenomegaly: A retrospective study

“…The findings of the present study indicated that the amount of blood PLTs was significantly higher 2 weeks after the surgery (P<0.05), although the difference between the preoperative number of blood PLTs and those present one week later was not significant (P>0.05). The number of PLTs clearly increased, which led to the formation of portal vein thrombosis following splenectomy, with the rate of thrombosis up to 34.2% (32). Several of the patients required anticoagulant therapy.…”

“…The blood platelet (PLT) and white blood cell (WBC) counts decrease dramatically, with abnormal coagulation function. The traditional therapy for hypersplenism is splenectomy, and the preferred treatment of HCC is hepatectomy, so the treatment advocated from previous studies is hepatectomy combined with splenectomy (1)(2)(3)(4), although this procedure leads to severe coagulation disorder and lost immune function of the spleen; furthermore, the incidence of portal vein thrombosis is high following a splenectomy (5).…”