Synchronous hepatectomy and splenectomy for patients with BCLC stage 0/A hepatocellular carcinoma and clinically significant portal hypertension: A multicenter retrospective cohort study.

[BACKGROUND] Liver transplantation is restricted by high costs and donor shortages, necessitating exploration of alternative treatments for hepatocellular carcinoma (HCC) with significant portal hypertension (CSPH). This study examined whether synchronous hepatectomy and splenectomy (HS) improves survival over hepatectomy (H) in patients with BCLC stage 0/A HCC and CSPH.

[METHODS] A total of 525 patients with BCLC stage 0/A HCC and CSPH from 12 centers were under review. Among these, 300 patients underwent H (H group) and 225 underwent HS (HS group). Propensity score matching resulted in 157 matched pairs of patients. The study compared both short-term and long-term outcomes between the two groups.

[RESULTS] The HS group had higher rates of massive intraoperative bleeding (15.3 % vs. 6.4 %), abdominal bleeding (5.1 % vs. 0.6 %), and portal vein thrombosis (14.0 % vs. 3.8 %), but no significant differences in 30-day mortality or overall morbidity. In terms of long-term outcomes, the HS group showed better overall survival (59.0 vs. 48.0 months, P = 0.031) and recurrence-free survival (41.0 vs. 28.0 months, P = 0.017), with lower incidences of variceal bleeding (1.9 % vs. 7.6 %) and liver failure mortality (3.8 % vs. 13.4 %). Multivariate analysis identified splenectomy as a significant prognostic factor for improved OS and RFS.

[CONCLUSION] HS could be a reasonable alternative for patients with BCLC stage 0/A HCC and CSPH. This combined therapeutic strategy enhances long-term survival through various mechanisms while maintaining an acceptable level of perioperative risk.