Objective: To explore the benefit of splenectomy combined with curative treatment for patients with hepatocellular carcinoma (HCC) and portal hypertension (PH). Methods: The records of 239 patients with HCC and PH undergoing splenectomy combined with curative treatment were reviewed. Survival analysis was compared, and liver function one year later was reassessed. Results: The postoperative liver failure rates and mortality were 3.3% and 2.1%, respectively. The 1-, 3-, and 5-year overall survival (OS) rates were 95.1%, 73% and 47.5% for patients with Child-Pugh class A and 92.2%, 51.2% and 19.8% for Child-Pugh class B, respectively. The median survival time for patients with Child-Pugh scores of 5, 6, 7, 8, and 9 were 61.5, 51.3, 44.8, 33.7 and 23.4 months, respectively. After multivariable analysis, tumor size, tumor number, postoperative liver failure, and Child-Pugh score were independent risk factors for OS. Liver function ameliorated in 97% of patients who had Child-Pugh class B preoperatively. Conclusions: Patients with HCC and PH can benefit from splenectomy combined with curative treatment, especially those with Child-Pugh scores of 5, 6 and 7. Liver function ameliorated significantly at one year after splenectomy in patients with preoperative Child-Pugh class B.
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