Objective:To evaluate the survival benefit of combined splenectomy in patients with liver cancer complicated with portal hypertension after radical resection.Methods:Clinical data of 138 patients with liver cancer complicated with portal hypertension who underwent radical resection in Beijing You'an Hospital Affiliated to Capital Medical University from March 2011 to May 2019 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 84 patients were male and 54 female, aged from 26 to 76 years, with a median age of 55 years. According to different surgical methods and liver cancer stages, all patients were divided into radical resection combined with splenectomy group (HS group, n=96), including 48 cases of T1 stage liver cancer (HS1 group), 39 cases of T2 stage (HS2 group) and 9 cases of T3 stage (HS3 group). 42 patients withT1 stage liver cancer who received radical resection alone were used as controls (HA1 group). Survival analysis was performed by Kaplan-Meier method and Log-rank test. Perioperative status between two groups was compared by t test, Mann-Whitney U test or Chi-square test.Results:The median RFS and OS in the HS groupwere 22.3 and 46.0 months. The postoperative 1-, 2-, 5-year RFS were 90.2%, 76.5%, 51.0% in the HS1 group,48.6%, 24.3%, 10.8% in the HS2 group, and 42.9%, 28.6%, 28.6% in the HS3 group, respectively. The differences were statistically significant in the postoperative 1-, 2-, 5-year RFS among three groups (χ2=22.276, 26.206, 17.124; P<0.05). The postoperative 1-, 2-, 5-year OS were 95.8%, 79.2%, 47.9% in the HS1 group, 84.6%, 69.2%, 25.6% in the HS2 group, and 77.7%, 55.6%, 33.3% in the HS3 group, respectively. The differences in the postoperative 5-year OS were statistically significant among three groups (χ2=11.416, P<0.05). In the HS1 and HA1 groups, the postoperative 1- and 2-year RFS were 95.0%, 81.0% and 81.3%, 66.7% respectively, and the differences were statistically significant (χ2=6.378, 4.944; P<0.05). In the HS1 and HA1 groups,20 and 2 patients had a history of varicose vein rupture and bleeding, and the difference was statistically significant (χ2=14.581, P<0.05). The median Hb before operation was 115(49) and 126(20) g/L, PTA was 73%(12%) and 78%(7%), liver stiffness was 19(12) and 15(10) kPa, intraoperative blood loss was 300(275) and 150(100) ml, operation time was 4.1(2.3) and 3.5(1.6) h, respectively. The differences were statistically significant (Z=-2.115, -2.768, 2.374, 3.171, 2.804; P<0.05). No patient died early after surgery in two groups.Conclusions:Combined splenectomy can improve early RFS of patients with T1 stage liver cancer complicated with portal hypertension after radical resection. A high proportion of preoperative gastrointestinal bleeding history, poor coagulation and high grade of liver cirrhosis are observed in these patients. Although combined splenectomy increases operation time and intraoperative bleeding, it is generally safe.
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