Concurrent partial splenic embolization with transcatheter arterial chemoembolization for hepatocellular carcinoma can maintain hepatic functional reserve

Ishikawa, Toru; Kubota, Tomoyuki; Horigome, Ryoko; Kimura, Naruhiro; Honda, Hiroki; Iwanaga, Akito; Seki, Keiichi; Honma, Teruki; Yoshida, Toshiaki

doi:10.1111/hepr.12222

Cited by 19 publications

(45 citation statements)

References 12 publications

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“…In patients with hepatocellular carcinoma, PSE has been combined with transcatheter arterial chemoembolization (TACE) for promising results. In a comparison of patients treated with TACE and concomitant PSE vs TACE alone, those in the combined treatment cohort demonstrated improvements in platelet counts and hepatic reserve [37] .…”

Section: Hematologic Indicesmentioning

confidence: 99%

Partial splenic artery embolization in cirrhotic patients

Hadduck¹,

McWilliams²

2014

WJR

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Splenomegaly is a common sequela of cirrhosis, and is frequently associated with decreased hematologic indices including thrombocytopenia and leukopenia. Partial splenic artery embolization (PSE) has been demonstrated to effectively increase hematologic indices in cirrhotic patients with splenomegaly. This is particularly valuable amongst those cirrhotic patients who are not viable candidates for splenectomy. Although PSE was originally developed decades ago, it has recently received increased attention. Presently, PSE is being utilized to address a number of clinical concerns in the setting of cirrhosis, including: decreased hematologic indices, portal hypertension and its associated sequela, and splenic artery steal syndrome. Following PSE patients demonstrate significant increases in platelets and leukocytes. Though progressive decline of hematologic indices occur following PSE, they remain improved as compared to pre-procedural values over long-term follow-up. PSE, however, is not without risk and complications of the procedure may occur. The most common complication of PSE is post-embolization syndrome, which involves a constellation of symptoms including fever, pain, and nausea/vomiting. The rate of complications has been shown to increase as the percent of total splenic volume embolized increases. The purpose of this review is to explore the current literature in regards to PSE in cirrhotic patients and to highlight their techniques, and statistically summarize their results and associated complications. Key words: Partial splenic embolization; Cirrhosis; Liver disease; Thrombocytopenia; Leukopenia Core tip: Splenomegaly is a common sequela of cirrhosis, and is frequently associated with decreased hematologic indices including thrombocytopenia and leukopenia. Partial splenic artery embolization (PSE) has been demonstrated to effectively increase hematologic indices in cirrhotic patients with splenomegaly. This is particularly valuable amongst cirrhotic patients that are not viable candidates for splenectomy. Although PSE was originally developed decades ago, it has recently received increased attention. Presently, PSE is being utilized to address a number of clinical concerns in the setting of cirrhosis, including: decreased hematologic indices, portal hypertension and its associated sequela, and splenic artery steal syndrome.Hadduck TA, McWilliams JP. Partial splenic artery embolization in cirrhotic patients. World J Radiol 2014; 6(5): 160-168 Available from:

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Section: Hematologic Indicesmentioning

confidence: 99%

Partial splenic artery embolization in cirrhotic patients

Hadduck¹,

McWilliams²

2014

WJR

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“…However, it was not mentioned whether the hematomas were caused by the low PLT count, poor coagulation function, or poor pressurization at the puncture site. Ishikawa et al (24) performed TACE (n=48) or TACE plus PSE (n=53) in 101 HCC patients with reduced PLT counts. There were no obvious complications after the procedure in either of the two groups, and the PLT count increased significantly after the procedure in the combined therapy group.…”

Section: Discussionmentioning

confidence: 99%

“…Our analysis also indicated that in only 16.3% of the procedures the WBC counts were reduced at 3 days after TACE. The increase in the WBC count following TACE is associated with the postoperative embolism syndrome (24), and a reduction in the WBC count is associated with chemotherapy-induced myelosuppression. In only 3 procedures (0.15%) agranulocytosis developed after TACE, but the WBC counts returned to pre-TACE levels following G-CSF treatment.…”

Section: Discussionmentioning

confidence: 99%

Perioperative safety analysis of transcatheter arterial chemoembolization for hepatocellular carcinoma patients with preprocedural leukopenia or thrombocytopenia

Zhou

Zhang

Wang

et al. 2017

Molecular and Clinical Oncology

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Abstract.Patients with hepatocellular carcinoma (HCC) exhibit a high incidence of concomitant cirrhosis with leukopenia and/or thrombocytopenia. In the present study, perioperative changes in the white blood cell (WBC) and platelet (PLT) counts and associated complications were investigated to assess the safety of transcatheter arterial chemoembolization (TACE) for HCC patients with preprocedural leukopenia or thrombocytopenia. The records of 1,461 HCC patients who received TACE between January 2012 and December 2013 were retrospectively reviewed. The incidence of complications during the perioperative period and changes in the WBC and PLT counts were recorded. A Chi -squared test was used to evaluate the associations between postoperative infection and preprocedural WBC count and between bleeding at the puncture site and preprocedural PLT count. The WBC count of the majority of the patients increased within 3 days and returned to the preprocedural level within 30 days after TACE. The PLT count decreased within 3 days and returned to the preprocedural level within 30 days after TACE. The major complications were liver decompensation (n=66), puncture site bleeding (n=45), infection (n=33), severe thrombocytopenia (n=8), upper gastrointestinal bleeding (n=6), tumor bleeding (n=4) and agranulocytosis (n=3). A Chi-squared test revealed that postoperative infection was not associated with preprocedural WBC count and puncture site bleeding was not associated with decreased PLT count due to hypersplenism. Therefore, TACE was found to be safe for HCC patients with preprocedural thrombocytopenia or leukopenia due to hypersplenism, with a low incidence of major complications during the perioperative period.

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“…First, the sharp decrease in the levels of WBCs and PLTs caused by hypersplenism raises the incidence of infection and hemorrhage, and secondly, chemotherapy or radiation therapy occasionally may be the only treatment for tumor recurrence following liver resection, although, since the counts of WBCs and PLTs are lower, these treatments would consequently be delayed. Hypersplenism and splenomegaly for liver cancer patients may be treated with minimally invasive surgery, such as partial splenic embolization, splenic irradiation and percutaneous injection of ethanolamine oleate, although these treatments are often associated with limitations and high complications (16)(17)(18)(19)(20).…”

Section: Discussionmentioning

confidence: 99%

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

Han

Kong

Ding

et al. 2016

Molecular and Clinical Oncology

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Abstract. The present retrospective study aimed to investigate the mid-term safety and efficacy of hepatectomy combined with microwave ablation of the partial spleen for treatment of liver cancer complicated with hypersplenism. A retrospective analysis was performed on 23 patients who underwent hepatectomy combined with microwave ablation of the partial spleen for liver cancer, complicated with hypersplenism that was secondary to cirrhosis. The splenic and ablated volumes were calculated according to a contrast-enhanced computed tomography scan prior to and 2 weeks after the operation. Complete blood count and liver function tests were examined prior to and following the surgery, and complications and changes in the blood tests were monitored for 6 months. Over this period of investigation, the splenic volume was reduced by a mean value of 34.0%. The levels of serum alanine aminotransferase and aspartate aminotransferase were increased on the first day after the operation (P<0.05), although they recovered to the normal level within 1 week (P<0.05). The total level of bilirubin increased slightly, along with moderately decreased levels of albumin and cholinesterase on the first day, although these changes were not significant compared with the baseline (P>0.05). The white blood cell count was persistently significantly higher compared with the baseline over the course of the 6 months (P>0.05). The platelet count did not increase significantly for the first week after the operation (P>0.05); however, it was revealed to be significantly increased 1 month after the surgery (P<0.05). No significant complications were occurred during the follow-up period. In conclusion, hepatectomy combined with microwave ablation of the spleen was demonstrated to be a safe and effective procedure for patients with liver cancer and hypersplenism in the mid-term.

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Concurrent partial splenic embolization with transcatheter arterial chemoembolization for hepatocellular carcinoma can maintain hepatic functional reserve

Cited by 19 publications

References 12 publications

Partial splenic artery embolization in cirrhotic patients

Partial splenic artery embolization in cirrhotic patients

Perioperative safety analysis of transcatheter arterial chemoembolization for hepatocellular carcinoma patients with preprocedural leukopenia or thrombocytopenia

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

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