A feasibility study of combining hepatectomy with splenectomy in hepatocellular carcinoma patients with severe thrombocytopenia / 中华肝胆外科杂志

ABSTRACT

Objective:To study the feasibility of combining hepatectomy with splenectomy in hepatocellular carcinoma patients with severe thrombocytopenia (platelet count ≤30×10 9/L). Methods:The data of 46 patients with primary hepatocellular carcinoma with thrombocytopenia treated at Beijing Ditan Hospital, Capital Medical University from January 2016 to January 2021 were analyzed retrospectively. There were 32 males and 14 females, aged (55.0±7.9) years. According to the platelet count one day before operation, the patients were divided into the study group (20×10 9/L < platelet count ≤30×10 9/L, n=20) and the control group (30×10 9/L<platelet count <100×10 9/L, n=26). All patients underwent hepatectomy combined with splenectomy or hepatectomy combined with splenectomy and pericardial devascularization. The liver function (aspartate aminotransferase, alanine aminotransferase, albumin), platelet count, daily abdominal drainage within 3 days after operation, drop in hemoglobin (the difference between hemoglobin on the day after operation versus 1 day before operation) and hospital stay were compared between the two groups. Rebleeding and portal vein thrombosis were studied. Results:There was no significant difference in liver function between the two groups 2 weeks after operation (all P>0.05). The platelet count on the 1st, 3rd and 5th day after operation in the study group was significantly lower than that in the control group (all P<0.05). The platelet count in the study group and the control group returned to the normal range on the 5th and 3rd day after operation, respectively. The daily abdominal drainage volume, drop in hemoglobin and hospital stay in the control group were (407.3±124.2) ml, (31.1±8.6) g and (13.7±3.3) d, respectively, which were significantly better than those in the study group (647.5±209.5) ml, (38.3±12.8) g, (16.9±3.7) d. There were 3 patients (15.0%) who developed esophageal and gastric fundus vein rebleeding and 10 patients (50.0%) with portal vein thrombosis in the study group, versus 2 patients (7.7%) and 12 patients (46.2%) respectively in the control group. There were no significant differences between the two groups (both P>0.05). Conclusion:Severe thrombocytopenia was not an absolute contraindication of combining hepatectomy and splenectomy in patients with hepatocellular carcinoma. After sufficient and reasonable preoperative adjustment and evaluation, the operation was still safe and feasible.