Simultaneous hepatectomy and splenectomy versus hepatectomy alone for hepatocellular carcinoma complicated by hypersplenism: a meta-analysis

BACKGROUND This study systematically compared the efficacy and safety of simultaneous hepatectomy and splenectomy (HS) with hepatectomy (H) alone in patients with hepatocellular carcinoma (HCC) and hypersplenism. METHODS The PubMed, Web of Science, Science Direct, EMBASE, and Cochrane Library databases were systematically searched by two independent researchers through to March 31, 2015 to identify relevant studies. All the extracted literature were managed by Bibliographic citation management software. Quality assessment of the included studies was performed using a modified Newcastle-Ottawa Scale judgment. The data were analyzed using RevMan5.2 software. RESULTS Eight studies including a total of 761 patients with HCC and hypersplenism (360 in the HS group, 401 in the H group) were finally included in the analysis. Outcomes, including postoperative complications, perioperative mortality, operation time, 5-year survival rate, and need for blood transfusion did not differ significantly between the two groups. HS was associated with significantly more intraoperative bleeding (mean difference [MD] 57.15, 95% confidence interval [CI] 18.83-95.46, P=0.003), and CD4/CD8 ratio (MD 0.69, 95% CI 0.61-0.77, P<0.00001), CD4 subset, platelet count (MD 213.06, 95% CI 202.59-223.53, P<0.0001), white blood cell count (MD 4.85, 95% CI 4.58-5.13, P<0.0001), interferon-gamma levels (MD 18.52, 95% CI 13.93-23.11, P<0.00001), and interleukin-2 levels (MD 20.73, 95% CI 16.05-25.41, P<0.0001). In addition, lower CD8 subset (MD -7.85, 95% CI -9.07, -6.63, P<0.00001) and interleukin-10 levels (MD -18.56, 95% CI -22.61, -14.50, P<0.00001) were observed for HS. CONCLUSION We identified that simultaneous HS do not increase postoperative complications, operation time, or perioperative mortality in patients with HCC and hypersplenism. Simultaneous splenectomy can increase postoperative white blood cell and platelet counts significantly, improve blood coagulation, reduce the incidence of postoperative bleeding, and enhance immunity. Therefore, HS is safe, effective, and feasible for patients with HCC and hypersplenism.