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Historically so far, splenectomy and partial splenic survival rates in HCC patients with a Japan Integrated Score
[7]
embolization (PSE) have achieved prolonged improvement of 0-1. However, the exacerbation of thrombocytopenia
[8]
[16]
for thrombocytopenia due to portal hypertension. Sugawara associated with arterial infusion of anticancer drugs in
et al. reported that patients with hypersplenism who patients with cirrhosis often restricts subsequent treatment
[9]
underwent combined treatment with splenectomy had options.
improved hepatic functional reserve and became eligible for
hepatectomy with post-operative 3- and 5-year survival rates Since both PSE and splenectomy are expected to improve
among patients with HCC associated with cirrhosis reaching the hepatic functional reserve, there are hopes that HCC
72.3% and 38.9%, respectively. However, whether splenectomy treatment combined with PSE represents a valuable treatment
should be performed simultaneously with HCC treatment modality for patients with thrombocytopenia.
is controversial. They recommended that simultaneous
splenectomy is appropriate for patients whose HCC could be We performed TACE combined with PSE and investigated
easily resected while simultaneously performing splenectomy whether these procedures, when performed simultaneously,
and who had a relatively stable general condition including could prevent thrombocytopenia, whether there were any
hepatic functional reserve, while patients who did not satisfy complications, and whether there was a secondary effect in
these criteria should first undergo splenectomy followed by the form of improved hepatic functional reserve. In the
[17]
assessment of the change in hepatic functional reserve and simultaneous PSE group, platelet count (×10 /μL) increased
4
only then be considered for secondary hepatectomy. from 6.54 ± 2.60 before TACE to 10.23 ± 3.93 at 2 weeks
after TACE, even though anti-cancer drugs were administered
Splenectomy is believed to be more effective in increasing during the TACE procedure. Meanwhile, in the TACE without
platelet counts than PSE. However, overwhelming PSE group, the platelet count (×10 /μL) decreased from
4
post-splenectomy infection (OPSI) and portal vein 6.89 ± 3.21 before TACE to 4.47 ± 1.55 at 2 weeks after
thrombosis (PVT) are major complications of splenectomy. [10,11] TACE. In the simultaneous PSE group, the increased platelet
OPSI has a high mortality rate and poor prognosis, especially count made it possible to perform loco-regional treatments
for patients with HCC. such as PEIT and RFA. Moreover, assessment of hepatic
reserve based on the Child-Pugh score showed that the PSE
Hence, Maddison first reported splenic embolization group experienced temporary worsening from 7.04 ± 1.05
[12]
as a treatment for hyper-splenectomy, in 1973; but its to 7.21 ± 0.99 at 2 weeks after TACE/PSE, but their scores
use was initially limited by severe complications such as later improved to 7.00 ± 1.77 at 2 months and 6.70 ± 1.16
splenic abscess and pneumonia with sepsis. Spigos et al., at 6 months after TACE/PSE.
[8]
however, described a PSE procedure for a limited infarct area
in 1979, leading to improved safety and enhanced clinical PROBLEMS WITH REDUCED SPLENIC FUNCTION
applications. Like splenectomy, PSE is reported to increase AFTER PSE
platelet counts and improve hepatic functional reserve and
portal hypertension. In the present review, the significance The occurrence of post-splenectomy sepsis (PSS) or OPSI after
and usefulness of PSE in the treatment of TACE for HCC are splenectomy or during reduced splenic function is thought to
discussed. be associated with a fatality rate of more than 70%.

HCC TREATMENT OF PATIENTS WITH The appearance of Howell-Jolly bodies in peripheral
THROMBOCYTOPENIA erythrocytes has drawn attention as an indicator of reduced
splenic function. Howell-Jolly bodies are erythrocyte
HCC is associated with severe complications in patients with inclusions shown by May-Giemsa staining while they do
cirrhosis or chronic hepatitis who have severe fibrosis. [13] not appear in healthy individuals, they are apparent in
certain blood diseases and in functional asplenia following
Although the treatment outcome of HCC has improved splenectomy. When we examined the incidence of
recently, intra-hepatic recurrence occurs at a high rate of Howell-Jolly bodies in patients who underwent PSE at our
10-25% annually despite radical treatment, and in many department, we found that they were present in as many as
patients, HCC recurrence leads to fatal consequences. We 17 of 95 treated patients (17.89%). [18]
[14]
previously reported that the combination of total hepatic
artery infusion of a powdered formulation of arterial Comparison with the group that was negative for Howell-Jolly
cisplatin (IA-Call; DDP-H) with TACE to treat Stage I/II HCC bodies did not reveal any significant differences in residual
reduced intra-hepatic distant recurrence and improved spleen volume or the splenic infarction rate after PSE.
[15]
156 Hepatoma Research | Volume 1 | Issue 3 | October 15, 2015