Efficacy of splenectomy for hypersplenic patients with advanced hepatocellular carcinoma

Hirooka, Masashi; Ishida, Kiyotaka; Kisaka, Yoshiyasu; Uehara, Takeki; Watanabe, Yuji; Hiasa, Yoichi; Michitaka, Kojiro; Onji, Morikazu

doi:10.1111/j.1872-034x.2008.00389.x

Cited by 17 publications

(29 citation statements)

References 23 publications

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“…Splenectomy has recently been reported to play a role in the surgical strategy for HCC and interferon-based therapy for hepatitis C [40][41][42][43][44][45] . In addition, it can improve the prognosis for patients with cirrhosis by allowing them to receive interferon therapy or undergo treatment for HCC [44,45] .…”

Section: Etiology Of Pvt In Cirrhosismentioning

confidence: 99%

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Portal vein thrombosis in liver cirrhosis

Kinjo¹,

Kawanaka²,

Akahoshi³

et al. 2014

WJH

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Portal vein thrombosis (PVT) is considered to be a frequent complication of liver cirrhosis. However, unlike PVT in patients without cirrhosis, very few data are available on the natural history and management of PVT in cirrhosis, despite its association with potentially life-threatening conditions, such as gastroesophageal bleeding and acute intestinal ischemia. Moreover, no consensus regarding PVT in cirrhosis exists. Suggested causes of PVT in cirrhosis include reduced portal blood flow velocity, multiple congenital or acquired thrombophilic factors, inherited or acquired conditions, and derangement of liver architecture. However, the understanding of PVT in cirrhosis is incomplete. In addition, information on the management of PVT in cirrhosis is inadequate. The aims of this review are to: (1) assemble data on the physiopathological mechanism, clinical findings, diagnosis and management of PVT in cirrhosis; (2) describe the principal factors most frequently involved in PVT development; and (3) summarize the recent knowledge concerning diagnostic and therapeutic procedures.© 2014 Baishideng Publishing Group Co., Limited. All rights reserved.Key words: Portal vein thrombosis; Liver cirrhosis; Thrombophilic factors; Anticoagulation; Splenectomy Core tip: Portal vein thrombosis (PVT) is considered to be a frequent complication of liver cirrhosis; however, very few data are available on the natural history and management of PVT in cirrhosis, despite its association with potentially life-threatening conditions. The understanding and information on the management of PVT in cirrhosis are incomplete. The aims of this review are to: (1) assemble data on the physiopathological mechanism, clinical findings, diagnosis and management of PVT in cirrhosis; (2) describe the principal factors most frequently involved in PVT development; and (3) summarize the recent knowledge concerning diagnostic and therapeutic procedures.

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Section: Etiology Of Pvt In Cirrhosismentioning

confidence: 99%

“…In addition, it can improve the prognosis for patients with cirrhosis by allowing them to receive interferon therapy or undergo treatment for HCC [44,45] . Despite the good results demonstrated in these studies, the high prevalence of PVT after splenectomy in patients with cirrhosis remains problematic [39,46] .…”

Section: Etiology Of Pvt In Cirrhosismentioning

confidence: 99%

Portal vein thrombosis in liver cirrhosis

Kinjo¹,

Kawanaka²,

Akahoshi³

et al. 2014

WJH

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“…Hypersplenic thrombocytopenia interferes with treatments such as hepatectomy, radiofrequency ablation (RFA), and transcatheter hepatic arterial chemoembolization (TACE) in patients with liver cirrhosis and hepatocellular carcinoma (HCC) [2][3][4]. In such cirrhotic patients with hypersplenic thrombocytopenia, splenectomy has recently been shown to improve the outcome of hepatectomy for HCC [5], allow the induction of interferon (IFN) therapy for hepatitis C viral (HCV) infection [6], and modulate portal venous pressure in living-donor liver transplantation [7].…”

Section: Introductionmentioning

confidence: 99%

Long-Term Outcome of Splenectomy in Advanced Cirrhotic Patients with Hepatocellular Carcinoma and Thrombocytopenia

et al. 2013

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Summary: Splenectomy may be a treatment option in hepatocellular carcinoma (HCC) and cirrhosis when there is no potential donor for liver transplantation. We retrospectively investigated the long-term outcome of splenectomy on survival in advanced cirrhotic patients with HCC and thrombocytopenia. Between 1999 and 2009, 46 cirrhotic patients with thrombocytopenia (Child-Pugh class B or C) who underwent splenectomy for the simultaneous or secondary treatment of HCC at our institute were evaluated. The 1-, 3-, and 5-year survival rates were 93.5, 76.0, and 37.9%, respectively. Splenectomy resulted in a significant reduction in mean portal venous pressure from 21.2 to 16.8 mmHg and improvements in liver function tests such as total bilirubin, prothrombin time, platelet count, Child-Pugh score for 3 years, and albumin for 2 years. The mean frequency of treatment for HCC recurrence after surgery was 3.0 times (range 1-11). Seven patients out of 16 scheduled for Interferon (IFN) therapy after surgery achieved a sustained virological response (SVR). Multivariate analysis identified SVR after IFN therapy as an independent significant prognostic factor (Hazard ratio 0.18, 95%CI 0.03-0.65, P=0.006). Postoperative complications including liver failure (n=1), portal thrombosis (n=7), ascites (n=5), and bacterial infections (n=4) were observed in 14 patients (30%). Splenectomy can be a feasible supportive therapy for the continuation of anticancer therapy and completion of IFN therapy based on improvements in liver function and thrombocytopenia with minimum complications in patients with HCC and advanced cirrhosis with no potential donor.

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“…Therefore, we have a relatively high proportion of severe end stage patients desiring intensive care. Although splenectomy and arterial splenic embolization are efficient methods for treating HCC patients with severe thrombocytopenia [7][8][9][10], these treatment options are not always available for patients with advanced liver cirrhosis. Thus, severe thrombocytopenia is still a major unresolved issue affecting HCC treatment, and eltrombopag, a thrombopoietin-receptor agonist, is expected to improve HCC treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, thrombocytopenia is an important factor that can interfere with clinical treatments in patients with chronic liver diseases. Splenectomy or partial splenic embolization is generally considered an effective therapeutic approach for thrombocytopenia [7][8][9][10]. However, these therapeutic procedures are invasive and are not always an option for patients with advanced chronic liver diseases like liver cirrhosis.…”

Section: Introductionmentioning

confidence: 99%

Thrombocytopenia, an Important Interfering Factor of Antiviral Therapy and Hepatocellular Carcinoma Treatment for Chronic Liver Diseases

et al. 2009

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Summary:In patients with chronic liver diseases, thrombocytopenia is a common manifestation which interferes with antiviral therapy for hepatitis C virus (HCV), and with hepatocellular carcinoma (HCC) treatment. While thrombopoietin-receptor agonist is expected to improve thrombocytopenia for patients with chronic liver diseases in 2-3 weeks, there is still a lack of fundamental data about short-term variations in the natural course of platelet count in cirrhotic patients, and the impact of thrombocytopenia on antiviral therapy for HCV-infected patients and patients being treated for HCC. The aims of this study are to investigate sequential changes in platelet count and the impact of thrombocytopenia on antiviral therapy and HCC treatment in patients with chronic liver diseases. A total of 726 chronic liver disease patients were enrolled in this study. Changes of platelet count were examined during a 4-week follow-up. Risk of discontinuation or reduction of peginterferon dosage was evaluated in HCV patients with moderate thrombocytopenia (5-10×10 4 /μL). Risk of platelet transfusion or splenectomy was evaluated in HCC patients with severe thrombocytopenia (<5×10 4 /μL). No significant changes of platelet count were observed in cirrhotic patients with thrombocytopenia during a 4-week follow-up. The rate of discontinuation or reduction in dosage of peginterferon was 85.2% (23/27) in patients with moderate thrombocytopenia. Risk of discontinuation or reduction of peginterferon dosage was 3.4-times higher in HCV patients with thrombocytopenia than in those without thrombocytopenia. In HCC patients with severe thrombocytopenia, the frequency of platelet transfusion or splenectomy during HCC treatment was 57.9% (22/38). Risk of platelet transfusion or splenectomy in HCC patients with thrombocytopenia was 57.9-times higher than in those without thrombocytopenia. In conclusion, we demonstrated no significant variation in the short-term natural course of platelet count in cirrhotic patients. In chronic liver disease patients with moderate and severe thrombocytopenia, about 85% of patients treated with peginterferon, and 60% of patients receiving HCC treatments suffered from thrombocytopenia-related limitations, respectively.

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Efficacy of splenectomy for hypersplenic patients with advanced hepatocellular carcinoma

Abstract: Splenectomy is an efficient method for advanced HCC patients with hypersplenism treated by chemotherapy.

Cited by 17 publications

References 23 publications

Portal vein thrombosis in liver cirrhosis

Portal vein thrombosis in liver cirrhosis

Long-Term Outcome of Splenectomy in Advanced Cirrhotic Patients with Hepatocellular Carcinoma and Thrombocytopenia

Thrombocytopenia, an Important Interfering Factor of Antiviral Therapy and Hepatocellular Carcinoma Treatment for Chronic Liver Diseases

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