Splenectomy and hepatocellular carcinoma: Cause or confounder?

Abstract

While splenectomy has been associated with hepatocellular carcinoma (HCC) in cirrhotic patients, its role as a direct carcinogenic factor remains controversial. This letter argues that the primary risk of HCC stems from the underlying liver disease rather than the surgical removal of the spleen itself. Current literature is based mostly on retrospective analyses lacking randomized controlled trials. Moreover, there is insufficient evidence to suggest that splenectomy in non-cirrhotic patients increases HCC risk. Prospective multicenter studies are needed to clarify the causal relationship.

Keywords: Splenectomy; Hepatocellular carcinoma; Liver cirrhosis; Hypersplenism; Portal hypertension

Core Tip: This letter challenges the notion that splenectomy itself increases hepatocellular carcinoma risk. This letter emphasize that the primary driver is underlying liver disease, not splenectomy. Current evidence is largely based on retrospective studies, and well-designed prospective or randomized trials are needed to determine any independent effect of splenectomy on hepatocarcinogenesis.