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Simultaneous hepatectomy and splenectomy versus hepatectomy alone for hepatocellular carcinoma complicated by hypersplenism: a meta-analysis.

Li W, Shen SQ, Wu SM, Chen ZB, Hu C, Yan RC - Onco Targets Ther (2015)

Bottom Line: Outcomes, including postoperative complications, perioperative mortality, operation time, 5-year survival rate, and need for blood transfusion did not differ significantly between the two groups.HS was associated with significantly more intraoperative bleeding (mean difference [MD] 57.15, 95% confidence interval [CI] 18.83-95.46, P=0.003), and CD4/CD8 ratio (MD 0.69, 95% CI 0.61-0.77, P<0.00001), CD4 subset, platelet count (MD 213.06, 95% CI 202.59-223.53, P<0.0001), white blood cell count (MD 4.85, 95% CI 4.58-5.13, P<0.0001), interferon-gamma levels (MD 18.52, 95% CI 13.93-23.11, P<0.00001), and interleukin-2 levels (MD 20.73, 95% CI 16.05-25.41, P<0.0001).Simultaneous splenectomy can increase postoperative white blood cell and platelet counts significantly, improve blood coagulation, reduce the incidence of postoperative bleeding, and enhance immunity.

View Article: PubMed Central - PubMed

Affiliation: Department of General Surgery, Renmin Hospital of Wuhan University, Wuhan, People's Republic of China.

ABSTRACT

Background: This study systematically compared the efficacy and safety of simultaneous hepatectomy and splenectomy (HS) with hepatectomy (H) alone in patients with hepatocellular carcinoma (HCC) and hypersplenism.

Methods: The PubMed, Web of Science, Science Direct, EMBASE, and Cochrane Library databases were systematically searched by two independent researchers through to March 31, 2015 to identify relevant studies. All the extracted literature were managed by Bibliographic citation management software. Quality assessment of the included studies was performed using a modified Newcastle-Ottawa Scale judgment. The data were analyzed using RevMan5.2 software.

Results: Eight studies including a total of 761 patients with HCC and hypersplenism (360 in the HS group, 401 in the H group) were finally included in the analysis. Outcomes, including postoperative complications, perioperative mortality, operation time, 5-year survival rate, and need for blood transfusion did not differ significantly between the two groups. HS was associated with significantly more intraoperative bleeding (mean difference [MD] 57.15, 95% confidence interval [CI] 18.83-95.46, P=0.003), and CD4/CD8 ratio (MD 0.69, 95% CI 0.61-0.77, P<0.00001), CD4 subset, platelet count (MD 213.06, 95% CI 202.59-223.53, P<0.0001), white blood cell count (MD 4.85, 95% CI 4.58-5.13, P<0.0001), interferon-gamma levels (MD 18.52, 95% CI 13.93-23.11, P<0.00001), and interleukin-2 levels (MD 20.73, 95% CI 16.05-25.41, P<0.0001). In addition, lower CD8 subset (MD -7.85, 95% CI -9.07, -6.63, P<0.00001) and interleukin-10 levels (MD -18.56, 95% CI -22.61, -14.50, P<0.00001) were observed for HS.

Conclusion: We identified that simultaneous HS do not increase postoperative complications, operation time, or perioperative mortality in patients with HCC and hypersplenism. Simultaneous splenectomy can increase postoperative white blood cell and platelet counts significantly, improve blood coagulation, reduce the incidence of postoperative bleeding, and enhance immunity. Therefore, HS is safe, effective, and feasible for patients with HCC and hypersplenism.

No MeSH data available.


Related in: MedlinePlus

Meta-analysis of comparison between HS and H groups for (A) perioperative mortality, (B) postoperative complications, (C) intraoperative bleeding, (D) operation time, (E) blood transfusion, and (F) 5-year overall survival rates.Abbreviations: HS, simultaneous hepatectomy and splenectomy; H, hepatectomy; CI, confidence interval; M–H, Mantel–Haenszel test; IV, inverse variance; SD, standard deviation.
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f3-ott-8-2129: Meta-analysis of comparison between HS and H groups for (A) perioperative mortality, (B) postoperative complications, (C) intraoperative bleeding, (D) operation time, (E) blood transfusion, and (F) 5-year overall survival rates.Abbreviations: HS, simultaneous hepatectomy and splenectomy; H, hepatectomy; CI, confidence interval; M–H, Mantel–Haenszel test; IV, inverse variance; SD, standard deviation.

Mentions: With respect to operation-related outcomes, five endpoints, including postoperative complications, perioperative mortality, operation time, intraoperative blood loss, and need for blood transfusion were analyzed. Three studies reported peri-operative mortality.17,18,20 Overall, perioperative mortality did not differ significantly between the two surgical approaches (OR 0.48, 95% CI 0.09–2.50, P=0.38; Figure 3A). Seven studies reported postoperative complications.17–22,24 Post operative complications were assessed with no significant difference between the two surgical approaches for patients with HCC and hypersplenism (OR 0.84, 95% CI 0.60–1.17, P=0.29; Figure 3B). Six studies reported intraoperative blood loss.17–19,21,22,24 More intraoperative blood loss was found with simultaneous HS, which was highly significant (MD 57.15, 95% CI 18.83–95.46, P=0.003; Figure 3C). Four studies reported operation time,17–19,21 which was not significantly different between the two surgical approaches (MD 37.99, 95% CI −11.75, 87.73, P=0.13; Figure 3D). Moreover, three studies reported blood transfusion,17,19,24 which did not differ significantly between the two surgical approaches (OR 1, 95% CI 0.58–1.71, P=0.99; Figure 3E). In terms of long-term results, two studies were pooled for analysis19,20 and no significant difference in 5-year overall survival rates was observed between the two surgical approaches for patients with HCC and hypersplenism (risk difference 0.08, 95% CI −0.03, 0.19, P=0.18; Figure 3F).


Simultaneous hepatectomy and splenectomy versus hepatectomy alone for hepatocellular carcinoma complicated by hypersplenism: a meta-analysis.

Li W, Shen SQ, Wu SM, Chen ZB, Hu C, Yan RC - Onco Targets Ther (2015)

Meta-analysis of comparison between HS and H groups for (A) perioperative mortality, (B) postoperative complications, (C) intraoperative bleeding, (D) operation time, (E) blood transfusion, and (F) 5-year overall survival rates.Abbreviations: HS, simultaneous hepatectomy and splenectomy; H, hepatectomy; CI, confidence interval; M–H, Mantel–Haenszel test; IV, inverse variance; SD, standard deviation.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4548766&req=5

f3-ott-8-2129: Meta-analysis of comparison between HS and H groups for (A) perioperative mortality, (B) postoperative complications, (C) intraoperative bleeding, (D) operation time, (E) blood transfusion, and (F) 5-year overall survival rates.Abbreviations: HS, simultaneous hepatectomy and splenectomy; H, hepatectomy; CI, confidence interval; M–H, Mantel–Haenszel test; IV, inverse variance; SD, standard deviation.
Mentions: With respect to operation-related outcomes, five endpoints, including postoperative complications, perioperative mortality, operation time, intraoperative blood loss, and need for blood transfusion were analyzed. Three studies reported peri-operative mortality.17,18,20 Overall, perioperative mortality did not differ significantly between the two surgical approaches (OR 0.48, 95% CI 0.09–2.50, P=0.38; Figure 3A). Seven studies reported postoperative complications.17–22,24 Post operative complications were assessed with no significant difference between the two surgical approaches for patients with HCC and hypersplenism (OR 0.84, 95% CI 0.60–1.17, P=0.29; Figure 3B). Six studies reported intraoperative blood loss.17–19,21,22,24 More intraoperative blood loss was found with simultaneous HS, which was highly significant (MD 57.15, 95% CI 18.83–95.46, P=0.003; Figure 3C). Four studies reported operation time,17–19,21 which was not significantly different between the two surgical approaches (MD 37.99, 95% CI −11.75, 87.73, P=0.13; Figure 3D). Moreover, three studies reported blood transfusion,17,19,24 which did not differ significantly between the two surgical approaches (OR 1, 95% CI 0.58–1.71, P=0.99; Figure 3E). In terms of long-term results, two studies were pooled for analysis19,20 and no significant difference in 5-year overall survival rates was observed between the two surgical approaches for patients with HCC and hypersplenism (risk difference 0.08, 95% CI −0.03, 0.19, P=0.18; Figure 3F).

Bottom Line: Outcomes, including postoperative complications, perioperative mortality, operation time, 5-year survival rate, and need for blood transfusion did not differ significantly between the two groups.HS was associated with significantly more intraoperative bleeding (mean difference [MD] 57.15, 95% confidence interval [CI] 18.83-95.46, P=0.003), and CD4/CD8 ratio (MD 0.69, 95% CI 0.61-0.77, P<0.00001), CD4 subset, platelet count (MD 213.06, 95% CI 202.59-223.53, P<0.0001), white blood cell count (MD 4.85, 95% CI 4.58-5.13, P<0.0001), interferon-gamma levels (MD 18.52, 95% CI 13.93-23.11, P<0.00001), and interleukin-2 levels (MD 20.73, 95% CI 16.05-25.41, P<0.0001).Simultaneous splenectomy can increase postoperative white blood cell and platelet counts significantly, improve blood coagulation, reduce the incidence of postoperative bleeding, and enhance immunity.

View Article: PubMed Central - PubMed

Affiliation: Department of General Surgery, Renmin Hospital of Wuhan University, Wuhan, People's Republic of China.

ABSTRACT

Background: This study systematically compared the efficacy and safety of simultaneous hepatectomy and splenectomy (HS) with hepatectomy (H) alone in patients with hepatocellular carcinoma (HCC) and hypersplenism.

Methods: The PubMed, Web of Science, Science Direct, EMBASE, and Cochrane Library databases were systematically searched by two independent researchers through to March 31, 2015 to identify relevant studies. All the extracted literature were managed by Bibliographic citation management software. Quality assessment of the included studies was performed using a modified Newcastle-Ottawa Scale judgment. The data were analyzed using RevMan5.2 software.

Results: Eight studies including a total of 761 patients with HCC and hypersplenism (360 in the HS group, 401 in the H group) were finally included in the analysis. Outcomes, including postoperative complications, perioperative mortality, operation time, 5-year survival rate, and need for blood transfusion did not differ significantly between the two groups. HS was associated with significantly more intraoperative bleeding (mean difference [MD] 57.15, 95% confidence interval [CI] 18.83-95.46, P=0.003), and CD4/CD8 ratio (MD 0.69, 95% CI 0.61-0.77, P<0.00001), CD4 subset, platelet count (MD 213.06, 95% CI 202.59-223.53, P<0.0001), white blood cell count (MD 4.85, 95% CI 4.58-5.13, P<0.0001), interferon-gamma levels (MD 18.52, 95% CI 13.93-23.11, P<0.00001), and interleukin-2 levels (MD 20.73, 95% CI 16.05-25.41, P<0.0001). In addition, lower CD8 subset (MD -7.85, 95% CI -9.07, -6.63, P<0.00001) and interleukin-10 levels (MD -18.56, 95% CI -22.61, -14.50, P<0.00001) were observed for HS.

Conclusion: We identified that simultaneous HS do not increase postoperative complications, operation time, or perioperative mortality in patients with HCC and hypersplenism. Simultaneous splenectomy can increase postoperative white blood cell and platelet counts significantly, improve blood coagulation, reduce the incidence of postoperative bleeding, and enhance immunity. Therefore, HS is safe, effective, and feasible for patients with HCC and hypersplenism.

No MeSH data available.


Related in: MedlinePlus