Liver transplantation with simultaneous splenectomy increases risk of cancer development and mortality in hepatocellular carcinoma patients

doi:10.4240/wjgs.v14.i9.930

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World Journal of Gastrointestinal Surgery

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Retrospective Study

World J Gastrointest Surg. Sep 27, 2022; 14(9): 930-939
Published online Sep 27, 2022. doi: 10.4240/wjgs.v14.i9.930

Liver transplantation with simultaneous splenectomy increases risk of cancer development and mortality in hepatocellular carcinoma patients

Hsiu-Lung Fan, Chung-Bao Hsieh, Shih-Ming Kuo, Teng-Wei Chen

Hsiu-Lung Fan, Chung-Bao Hsieh, Teng-Wei Chen, Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11409, Taiwan

Shih-Ming Kuo, Division of Pediatric Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11409, Taiwan

Author contributions: Fan HL participated in data analysis and the writing of the paper; Hsieh CB participated in research design; Kuo SM participated in research design; Chen TW participated in data interpretation and revision of the paper

Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Tri-Service General Hospital, No. 2-108-05-127.

Informed consent statement: Informed consent was not required by the guidance of the institutional review board because this study was a retrospective study and the analysis used clinical data anonymously.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

Data sharing statement: No additional data are available.

Corresponding author: Teng-Wei Chen, MD, Associate Professor, Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec 2, Chen-Kung Road, Neihu 114, Taipei 11409, Taiwan. tengweichen@yahoo.com.tw

Received: April 13, 2022
Peer-review started: April 13, 2022
First decision: May 9, 2022
Revised: May 24, 2022
Accepted: August 24, 2022
Article in press: August 24, 2022
Published online: September 27, 2022
Processing time: 161 Days and 23.3 Hours

Abstract

BACKGROUND

Splenectomy has previously been found to increase the risk of cancer development, including lung, non-melanoma skin cancer, leukemia, lymphoma, Hodgkin’s lymphoma, and ovarian cancer. The risk of cancer development in liver transplantation (LT) with simultaneous splenectomy remains unclear.

AIM

To compare hepatocellular carcinoma (HCC) recurrence and de novo malignancy between patients undergoing LT with and without simultaneous splenectomy.

METHODS

We retrospectively analyzed the outcomes of 120 patients with HCC within the University of California San Francisco criteria who received LT with (n = 35) and without (n = 85) simultaneous splenectomy in the Tri-Service General Hospital. Univariate and multivariate Cox regression analyses for cancer-free survival and mortality were established. The comparison of the group survival status and group cancer-free status was done by generating Kaplan–Meier survival curves and log-rank tests.

RESULTS

The splenectomy group had more hepatitis C virus infection, lower platelet count, higher -fetoprotein level, and longer operating time. Splenectomy and age were both positive independent factors for prediction of cancer development [hazard ratio (HR): 2.560 and 1.057, respectively, P < 0.05]. Splenectomy and hypertension were positive independent factors for prediction of mortality. (HR: 2.791 and 2.813 respectively, P < 0.05). The splenectomy group had a significantly worse cancer-free survival (CFS) and overall survival (OS) curve compared to the non-splenectomy group (5-year CFS rates: 53.4% vs 76.5%, P = 0.003; 5-year OS rate: 68.1 vs 89.3, P = 0.002).

CONCLUSION

Our study suggests that simultaneous splenectomy should be avoided as much as possible in HCC patients who have undergone LT.

Keywords: Hepatocellular carcinoma; Liver transplantation; Splenectomy; De novo malignancy; Age; Hypertension

Core tip: This retrospective study compared the outcomes of hepatocellular carcinoma (HCC) recurrence and de novo malignancy development between HCC patients who underwent liver transplantation (LT) with and without simultaneous splenectomy. Splenectomy leads to a significantly higher risk of cancer development after LT and is a significant risk factor of mortality. Simultaneous splenectomy should be avoided as much as possible.