Appraisal of hepatic resection in the treatment of hepatocellular carcinoma with severe thrombocytopenia

Background: Hepatic resection for hepatocellular carcinoma (HCC) patients with liver cirrhosis and severe hypersplenic thrombocytopenia is risky and controversial. Methods: From 1989 to 2005, 341 patients underwent hepatic resection for HCC in our hospital. Of these, 15 patients were concomitant with severe thrombocytopenia (platelet count, ≤5 × 10⁴/mm ³), and their clinical outcomes were retrospectively reviewed. Results: Among the 15 patients, 11 underwent hepatectomy alone and 4 underwent concomitant splenectomy. The mean preoperative platelet count was 4.2 ± 0.8 × 10⁴/mm³ (range, 1.9-5 x 10⁴/mm ³). The surgical procedures performed were partial resection in five patients, subsegmentectomy in three, and segmentectomy in seven. A blood transfusion was required for 11 of 15 patients, and 8 of these received a platelet-rich plasma transfusion. With the exception of one patient who suffered from postoperative liver failure, all the patients had an uneventful postoperative course. The 3-year cumulative survival rate of these patients was comparable to those without thrombocytopenia. Conclusions: Severe thrombocytopenia alone is not a contraindication for hepatectomy in patients with HCC associated with liver cirrhosis. For these patients, hepatic resection-hepatectomy alone or concomitant splenectomy-should be considered as a treatment option.