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Impact of Splenic Volume and Splenectomy on Prognosis of Hepatocellular Carcinoma Within Milan Criteria After Curative Hepatectomy

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Abstract

Background

The prognosis of hepatocellular carcinoma (HCC) with portal hypertension (PH) is very poor. Splenomegaly is considered important evidence of PH. Our aim was to clarify the prognostic value of splenic volume (SV) and the effect of splenectomy on the prognosis of HCC within the Milan criteria after curative hepatectomy.

Methods

In this single-center retrospective study, we reviewed 160 patients with HCC that met the Milan criteria, including 138 who had undergone hepatectomy and 22 who had undergone hepatectomy and splenectomy between July 2004 and December 2010. SV was measured by three-dimensional computed tomography and patients allocated to three groups (high SV ≥300 mL; low <300 mL; and splenectomy) to compare post-hepatectomy survival rates.

Results

Multivariate analyses showed that SV is an independent prognostic factor for overall and disease-free survival. The overall survival rates at 5 years in the high SV, low SV, and splenectomy groups were 39, 75, and 88%, respectively. The overall survival rate in the high SV group was significantly worse than in the low SV and splenectomy groups (P < 0.001). There was no significant difference between the low SV and splenectomy groups (P = 0.831).

Conclusions

High SV is an independent predictor of post-hepatectomy HCC recurrence and overall survival. There is no significant difference in prognosis between low SV and splenectomy groups, even though the latter had high SV. Combined splenectomy with hepatectomy for HCC and PH may improve prognosis and be an appropriate alternative when liver transplantation cannot be performed.

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Abbreviations

HCC:

Hepatocellular carcinoma

PH:

Portal hypertension

SV:

Splenic volume

ICGR15 :

Indocyanine green dye retention rate at 15 min

CT:

Computed tomography

AFP:

α-Fetoprotein

DCP:

Des-gamma carboxyprothrombin

mVp:

Micro-portal vein tumor invasion

IM:

Intrahepatic metastasis

CI:

Confidence intervals

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Acknowledgements

This work was supported by a grant from Grants-in-Aid for Scientific Research from the Japan Society for the Promotion of Science (JSPS) (Grant Number 25670583) and Kaibara Morikazu Medical Science Promotion Foundation. The authors thank Professor Takeharu Yamanaka, Yokohama City University, for statistical advice and Dr.Trish Reynolds, MBBS, FRACP, from Edanz Group for editing a draft of this manuscript.

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Authors and Affiliations

  1. Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan

    Kazuki Takeishi, Shinji Itoh, Norifumi Harimoto, Toru Ikegami, Tomoharu Yoshizumi, Ken Shirabe & Yoshihiko Maehara

  2. Clinical Research Institute and Department of Surgery, National Beppu Medical Center, Beppu, Japan

    Hirofumi Kawanaka

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  1. Kazuki Takeishi
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  2. Hirofumi Kawanaka
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  3. Shinji Itoh
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Correspondence to Kazuki Takeishi.

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Takeishi, K., Kawanaka, H., Itoh, S. et al. Impact of Splenic Volume and Splenectomy on Prognosis of Hepatocellular Carcinoma Within Milan Criteria After Curative Hepatectomy. World J Surg 42, 1120–1128 (2018). https://doi.org/10.1007/s00268-017-4232-z

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