Hepatectomy combined with microwave ablation of the spleen for treatment of hepatocellular carcinoma complicated with splenomegaly: A retrospective study

Abstract

The present retrospective study aimed to investigate the mid-term safety and efficacy of hepatectomy combined with microwave ablation of the partial spleen for treatment of liver cancer complicated with hypersplenism. A retrospective analysis was performed on 23 patients who underwent hepatectomy combined with microwave ablation of the partial spleen for liver cancer, complicated with hypersplenism that was secondary to cirrhosis. The splenic and ablated volumes were calculated according to a contrast-enhanced computed tomography scan prior to and 2 weeks after the operation. Complete blood count and liver function tests were examined prior to and following the surgery, and complications and changes in the blood tests were monitored for 6 months. Over this period of investigation, the splenic volume was reduced by a mean value of 34.0%. The levels of serum alanine aminotransferase and aspartate aminotransferase were increased on the first day after the operation (P<0.05), although they recovered to the normal level within 1 week (P<0.05). The total level of bilirubin increased slightly, along with moderately decreased levels of albumin and cholinesterase on the first day, although these changes were not significant compared with the baseline (P>0.05). The white blood cell count was persistently significantly higher compared with the baseline over the course of the 6 months (P>0.05). The platelet count did not increase significantly for the first week after the operation (P>0.05); however, it was revealed to be significantly increased 1 month after the surgery (P<0.05). No significant complications were occurred during the follow-up period. In conclusion, hepatectomy combined with microwave ablation of the spleen was demonstrated to be a safe and effective procedure for patients with liver cancer and hypersplenism in the mid-term.

Keywords: hepatocellular carcinoma; hypersplenism; microwave ablation.

Figure 1.

Representative CT scans of one patient with hepatocellular carcinoma and hypersplenism due to liver cirrhosis who underwent partial hepatectomy and microwave ablation of the spleen. (A and B) Contrast-enhanced CT scans, revealing one neoplasm (indicated by the short arrows) in the left liver lobe and splenomegaly according to the diagnostic criteria. (C and D) Contrast-enhanced CT scans of the transverse section, revealing an unenhanced low-attenuation microwave ablation lesion (indicated by the long arrow) in the spleen, and an unenhanced low-density area, termed the remaining surgery cavity, after partial hepatectomy (shown by the dovetail arrow) in the left lobe of the liver 2 weeks after the operation. CT, computed tomography.

Figure 2.

Calculation of the splenic ablated volume. The splenic ablated volume was calculated on three-dimensional contrast-enhanced computed tomography scans 2 weeks after the operation. The surface of the spleen was no longer smooth, and the depressed areas were ablated lesions. One of the ablated areas (indicated by the long arrow) is highlighted.

Figure 3.

Spleen hematoma occurred in one patient following microwave ablation of the spleen. The plain CT scan revealed a lower-density area (indicated by the long arrow) under the spleen membrane, and the area began to shrink: As revealed on the routine plain CT scan following the operation, the spleen hematoma was absorbed gradually. (A) A plain CT scan, revealing the spleen hematoma 2 weeks after the operation. (B) The spleen hematoma had decreased in size one month later. (C) Spleen hematoma was absorbed almost completely 3 months post-operation.

Figure 4.

Changes in the counts of white blood cell and blood platelets after the operation. (A) The white blood cell count peaked on day 1 after the procedure, and subsequently gradually decreased over time, arriving at a stable level one month later. The white blood cell count still remained at the normal level 6 months after the operation. (B) The blood platelet count began to increase gradually after the treatment, and reached a peak level at 2 weeks after the operation; however, the platelet count did not increase significantly during the first week after the operation. *P>0.05 vs. the pre-operation.

Figure 5.

Changes in liver function following the operation. Levels of ALT and AST increased significantly on the first day after the operation, although they declined to the normal or preoperative level within one week. T-Bil increased steadily, whereas the levels of albumin deceased slightly. *P<0.05 vs. pre-operation. ALT, alanine aminotransferase; AST, aspartate aminotransferase; T-Bil, total bilirubin; ALB, albumin.