Synchronous splenectomy and hepatectomy for patients with hepatocellular carcinoma and hypersplenism: A case-control study

Table 1 Demographic data of the hepatectomy and splenectomy group and the hepatectomy alone group

Variable	HS group	HA group	P value
Number of patients (n)	84	84
Age (yr)	49.32 ± 10.485	51.01 ± 10.830	0.306
Gender (M/F)	69:15	69:15	1.000
HBsAg (positive/negative)	71:13	72:12	0.828
AFP (ng/mL)			0.633
≤ 400	54	51
> 400	30	33
White blood cell count (109/L)	3.96 ± 4.11	4.60 ± 4.41	0.332
Platelet count (109/L)	61.43 ± 42.113	68.93 ± 17.677	0.134
Splenomegaly(mild/moderate/severe)	12:46:36	14:53:27	0.380
Chlid-Pugh class (A)	84	84
Number of tumors
Single	11	11	1.000
Multiple	73	73
Diameter of tumor (cm)
Mean	4.18 ± 2.134	4.26 ± 1.996	0.809
≤ 5	13	18	0.320
> 5	71	66
Micro-vascular invasion
Yes	20	22	0.722
No	64	62

HS: Hepatectomy and splenectomy; HA: Hepatectomy alone; AFP: Alpha-fetoprotein; HBsAg: Hepatitis B surface antigen.

Table 2 Other clinical data and complication classification of the two groups

Variable	HS group (n = 84)	HA group (n = 84)	P value
Hospital stays (d)	9.71 ± 3.514	9.57 ± 5.267	0.899
Type of resection1 (major/minor)	20:64	32:52	0.066
Intraoperative bleeding (mL)	553.57 ± 281.316	498.21 ± 220.094	0.157
Transfusion (Y/N)	11/73	8/76	0.627
Recurrence	35	48	0.045
Time to recurrence (mo)
Mean time	21.11 ± 12.04	11.23 ± 8.73	0.001
≤ 12 mo	8	31	< 0.001
> 12 mo	27	17
Follow-up time (mo)	35.87 ± 16.16	33.45 ± 17.94	0.360
Upper gastrointestinal hemorrhage after operation	4	7	0.349

¹Major resection = Resection of three or more segments; Minor resection = Resection of two or fewer segments. HS: Hepatectomy and splenectomy; HA: Hepatectomy alone.

Table 3 Surgical complications classified by Clavien classification for the two groups

Clavien classification	HS group	HA group	P value
Grade I	21	22
(fever/pain/vomit/ wound infection/ ascites/hypokalemia)	(9/4/2/1/4/1)	(5/4/5/1/4/3)
Grade II(transfusion/infection/ coagulopathy/liver failure)	6(5/1/0/0)	10(2/5/2/1)
Grade IIIa	21	14
Grade IIIb	22	0
Grade VI	23	35
Grade V	-	-
Total	33	36	0.532

¹Two patients had pleural effusion and received pleurocentesis;

²Two patients were diagnosed with intra-abdominal bleeding and underwent re-laparotomy;

³Two patients were resuscitated and needed ICU management due to the hypotension and shock;

⁴One patient had pleural effusion and received pleurocentesis;

⁵Two patients suffered type I respiratory failure and 1 patient suffered hypotension and shock, all of whom needed ICU management. HS: Hepatectomy and splenectomy; HA: Hepatectomy alone.

Table 4 Laboratory tests of the two groups after surgery

Variable	Pre-operation			1 d			1 wk			1 mo			1 yr
	HS	HA	P value	HS	HA	P value	HS	HA	P value	HS	HA	P value	HS	HA	P value
TBIL (μmol/L)	17.94 ± 7.34	16.62 ± 6.63	0.415	22.34 ± 8.52	32.72 ± 27.14	0.026	24.04 ± 10.90	34.06 ± 48.89	0.216	15.12 ± 5.28	15.87 ± 6.70	0.858	17.20 ± 6.21	18.61 ± 5.82	0.314
ALT (IU/L)	35.90 ± 16.89	39.24 ± 14,54	0.519	213.85 ± 187.27	348.00 ± 342.49	0.036	112.00 ± 101.69	169.57 ± 154.49	0.058	43.49 ± 23.78	49.41 ± 21.62	0.860	39.82 ± 17.85	41.11 ± 34.53	0.838
AST (IU/L)	39.92 ± 15.69	47.16 ± 27.63	0.162	244.49 ± 186.49	321.81 ± 314.90	0.194	80.64 ± 77.53	64.19 ± 37.23	0.246	49.41 ± 21.62	44.22 ± 22.31	0.306	47.69 ± 27.73	48.00 ± 48.75	0.973
PLT count (109/L)	61.43 ± 42.11	68.93 ± 17.68	0.134	98.54 ± 33.27	67.11 ± 21.67	< 0.001	230.95 ± 114.95	74.65 ± 26.05	< 0.001	214.18 ± 102.03	73.24 ± 24.12	< 0.001	199.97 ± 58.19	68.08 ± 36.52	< 0.001
WBC count (109/L)	3.96 ± 4.11	4.60 ± 4.41	0.332	16.30 ± 5.38	11.79 ± 4.07	< 0.001	10.93 ± 4.27	6.14 ± 2.74	< 0.001	6.48 ± 1.71	4.25 ± 1.41	< 0.001	5.96 ± 1.46	4.48 ± 2.02	< 0.001

Both PLT and WBC counts in the HS group were alleviated and were significantly higher when compared to those in the HA group at one day, one week, one month and one year postoperatively (P < 0.001) (Figure 3A and B). While levels of the TBIL and ALT were much higher in the HA group than in the HS group on postoperative day one (P < 0.05), and then descended as similar as the HS group (Figure 3C and D). The level of AST did not differ between the two groups. TBIL: Total bilirubin; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; PLT: Platelet; WBC: White blood cell.

Table 5 Univariate and multivariate analyses of prognostic factors for disease-free survival

Variable	Univariate analysis		Multivariate analysis
	HR (95%CI)	P value	HR (95%CI)	P value
Splenectomy	0.498 (0.314-0.792)	0.003	0.531 (0.341-0.828)	0.005
Gender, F	0.873 (0.476-1.601)	0.661
Age, > 60 yr	0.836 (0.395-1.769)	0.639
HBsAg, positive	1.634 (0.716-3.727)	0.243
AFP, > 400 ng/mL	1.386 (0.881-2.180)	0.158
Platelet count	0.994 (0.985-1.003)	0.221
White blood cell count	1.037 (0.993-1.083)	0.1
Tumor number, multiple	1.668 (0.862-3.226)	0.129
Tumor size, > 5 cm	0.785 (0.446-1.381)	0.401
Micro-vascular invasion	2.766 (1.700-4.498)	<0.001	2.642 (1.685-4.143)	< 0.001

HBsAg: Hepatitis B surface antigen; AFP: Alpha-fetoprotein.

Table 6 Univariate and multivariate analyses of prognostic factors for overall survival

Variable	Univariate analysis		Multivariate analysis
	HR (95%CI)	P value	HR (95%CI)	P value
Splenectomy	0.862 (0.497-1.492)	0.595
Gender, F	0.466 (1.125-4.083)	0.020	0.774 (1.164-4.041)	0.015
Age, > 60 yr	0.876 (0.384-1.998)	0.752
HBsAg, positive	0.552 (0.259-1.176)	0.124
AFP, > 400 ng/mL	0.986 (0.563-1.728)	0.962
Platelet count	1.004 (0.995-1.013)	0.397
White blood cell count	0.975 (0.901-1.055)	0.533
Tumor number, multiple	2.216 (1.033-4.752)	0.041	0.801 (1.071-4.633)	0.032
Tumor size, > 5 cm	2.067 (1.087-3.930)	0.027	0.572 (0.991-3.169)	0.054
Micro-vascular invasion	0.624 (0.329-1.182)	0.148
Recurrence	14.376 (6.233-33.160)	< 0.001	2.344 (4.961-21.882)	< 0.001

HBsAg: Hepatitis B surface antigen; AFP: Alpha-fetoprotein.