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Review

Expectations for partial splenic arterial embolization
Expectations for partial splenic arterial embolization
simultaneous transcatheter arterial chemoembolization for
simultaneous transcatheter arterial chemoembolization for
hepatocellular carcinoma
hepatocellular carcinoma

Toru Ishikawa
Department of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital, Niigata 950-1104, Japan

ABSTRACT
Hepatocellular carcinoma (HCC) is frequently complicated by cirrhosis, and it is not unusual for treatment options to be limited
as a result of pancytopenia due to hypersplenism. Partial splenic embolization (PSE) has been performed for thrombocytopenia
resulting from hypersplenism. However, the safety and effi cacy of concurrent transcatheter arterial chemoembolization (TACE)
with PSE for HCC remain unclear. Thrombocytopenia has been improved, and treatment continued using concurrent PSE.
In addition, the hepatic functional reserve could be maintained even after treatment for HCC. Concurrent TACE and PSE
for HCC with thrombocytopenia can be expected to help maintain a hepatic reserve, and it may contribute to improving the
prognosis of HCC. Hence, PSE could lead to an asplenic state. The appearance of Howell-Jolly bodies on a peripheral
blood smear is reported useful for assessing splenic function. The appearance of Howell-Jolly bodies is associated with an
increased risk for post-splenectomy sepsis/overwhelming post-splenectomy infection in patients with reduced splenic function.
These bodies are frequently observed in peripheral erythrocytes after PSE, and when they are present, it is appropriate to
administer the pneumococcal vaccine to prevent severe infection. The expectations for PSE combined with TACE for the
treatment of HCC associated with cirrhosis are reviewed.

Key words: Hepatic functional reserve; hepatocellular carcinoma; partial splenic embolization; thrombocytopenia; transcatheter
arterial chemoembolization

Address for correspondence:
Dr. Toru Ishikawa, Department of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital, 280-7 Teraji, Niigata 950-1104, Japan.
E-mail: toruishi@ngt.saiseikai.or.jp
Received: 24-05-2015, Accepted: 18-06-2015

INTRODUCTION percutaneous ethanol injection therapy (PEIT), and
[4]
radiofrequency ablation (RFA) are all reported to be
[5]
Patients with cirrhosis develop hypersplenism (splenomegaly) effective in the treatment of HCC. There are various other
and decreased platelet counts as their liver fibrosis progresses. therapeutic alternatives including systemic chemotherapy,
[6]
[1]
Within this clinical context, hepatocellular carcinoma (HCC) is but thrombocytopenia is a major obstacle in the treatment of
frequently associated with cirrhosis. In addition to surgical HCC. In other words, HCC associated with cirrhosis is often
procedures such as hepatic resection, liver transplantation, characterized by pancytopenia due to hypersplenism, so it is
[2]
transcatheter arterial chemoembolization (TACE), not uncommon for treatment options to be limited.
[3]
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DOI: How to cite this article: Ishikawa T. Expectations for partial splenic arterial
10.4103/2394-5079.161284 embolization simultaneous transcatheter arterial chemoembolization for
hepatocellular carcinoma. Hepatoma Res 2015;1:155-8.

© 2015 Hepatoma Research | Published by Wolters Kluwer - Medknow 155