Splenectomy versus Partial Splenic Embolization for Massive Splenomegaly Secondary to Hepatitis B-Related Liver Cirrhosis: A Case-Control Study

Abstract

Background. Both splenectomy (SP) and partial splenic embolization (PSE) are used to treat massive splenomegaly (MSM) secondary to hepatitis B-related liver cirrhosis (HB-LC). This retrospective case-control study was conducted to compare the effects of SP and PSE on these patients. Methods. From July 2004 to January 2012, patients with MSM secondary to HB-LC who underwent SP or PSE were 1 : 1 : 1 matched with similar nonsurgery patients, respectively. Intraoperative situation, hematological indices, liver function, HBV DNA level, HBeAg seroconversion rate, morbidity, and mortality at 6 months postoperatively were compared. Results. Operative time, estimated blood loss, blood transfusion rate, severe pain, postoperative stay, and portal vein thrombosis (PVT) rate in the PSE group were significantly superior to the SP group, although SP and PSE were similar in liver function improvement, HBV suppression, morbidity, and mortality at 6 months postoperatively, and SP even improved WBC and PLT counts higher than PSE. Conclusion. Both SP and PSE are effective in improving liver function, increasing WBC and PLT counts, and suppressing replication of HBV for MSM secondary to HB-LC. Although postoperative improvement in WBC and PLT counts by SP can be higher than PSE, PSE is simple and minimally invasive and has a lower incidence of PVT.

Long-Term Efficacy and Safety of Partial Splenic Embolization in Hepatocellular Carcinoma Patients with Thrombocytopenia Who Underwent Transarterial Chemoembolization

“…Surgical splenectomy is another treatment option for patients with thrombocytopenia. However, it is invasive and reported to be associated with high incidence of portal vein thrombosis and mortality 161729…”

Human fibroblast growth factor-21 serves as a predictor and prognostic factor in patients with hepatitis B cirrhosis combined with adrenal insufficiency

“…Hepatitis B-induced liver cirrhosis poses a great threat to health and frequently leads to adrenal insufficiency that further affects the endocrine system and disturbs liver metabolism ( 27 , 28 ). Pathophysiologic and clinical evidences have suggested that inflammation is associated with hepatitis B-induced liver cirrhosis and inflammatory cytokines, including TNF and IL-1, which may be potential target agents in decompensated cirrhosis ( 29 ).…”

Incidence of Splanchnic Vein Thrombosis After Abdominal Surgery: A Systematic Review and Meta-analysis

“…These 48 articles reported the incidence of SVT within 1 y after surgery in which posthospital discharge VTE prophylaxis was not administered. 4,5, Agreement between reviewers regarding eligibility was excellent (k ¼ 0.84). The studies included one RCT, four prospective observational studies, and 43 retrospective observational studies.…”

“…The initial search identified 5549 articles. After abstracts and titles were screened, 630 articles were retrieved for full-text review, yielding 48 included articles, totaling 50,267 patients 4,5, (Fig. 1).…”

“…2,3 The incidence of SVT after major abdominal surgery varies; it has been reported to be from 0.08% in bariatric procedures 4 up to 29% after splenectomies. 5 Other predisposing factors for SVT include systemic factors, such as myeloproliferative disorders, inherited thrombophilia, neoplasm, and oral contraceptive use. Local factors include decreased portal blood flow due to ascites in the setting of cirrhosis, trauma to the portal venous system, and abdominal inflammatory conditions.…”