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 x 10(4)/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 x 10(4)/mm(3) (range, 1.9-5 x 10(4)/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.