Splenic arterial ligation prevents liver injury after a major hepatectomy by a reduction of surplus portal hypertension in hepatocellular carcinoma patients with cirrhosis

Background/Aims: In this study, we investigated whether a reduction of surplus portal hypertension after a major hepatectomy by SPL (splenic arterial ligation) prevents a liver injury in cirrhotic patients with hepatocellular carcinoma. Methodology: Six hepatocellular carcinoma patients (SPL group) with liver cirrhosis (67 +/- 10 years old, ICGR(15): 21.0 +/-9.8%, T.Bil: 1.1 +/-1.2mg/dL) underwent major hepatectomy with splenic arterial ligation in order to reduce excessive portal hypertension after hepatectomy from 1998 to 2000, July. The patients (n=15, 60 +/-9 years old, ICGR(15): 11.5 +/-5.9%, T.Bil: 0.66 +/-0.15mg/dL) who underwent liver resection above subsegmentectomy in the same period (control group) served as the control for SPL group. Results: In the SPL group, the portal pressures before hepatectomy were 26 +/- 7cm H2O and those after hepatectomy were 29 +/- 6cm H2O. The portal pressure after splenic arterial ligation decreased to 24.5 +/-6.3cm H2O. The splenic tissue blood flows before SPL were 16.8 +/-5.6mL/min/100g, while those after SPL were 7.2 +/-2.2mL/min/100g. The portal pressures before hepatectomy were 17 +/- 2cm H2O and those after hepatectomy were 19 +/- 2cm H2O in the six control patients. At the peak levels of liver function after surgery, T.Bil was 2.6 +/-1.5mg/dL, GOT was 165 +/- 59 IU/L, and GPT was 107 +/- 49 IU/L. Ah patients could discharge without complications except for one case with bile leakage in SPL. At the peak levels of liver function in control group, T.Bil was 3.7 +/-1.9mg/dL, GOT was 404+/227 IU/L, and GPT was 322 +/- 171 IU/L. At the peak levels of Liver function after surgery, T.Bil was 3.4 +/-1.3mg/dL, GOT was 398 +/- 289 IU/L, and GPT was 319 +/- 220 IU/L. Conversely, there were 11 episodes of complications (11/15), including two cases of hospital death resulting from liver failure in patients who underwent right lobectomy, in the control patients. Conclusions: The decompression of surplus portal hypertension by SPL might be effective in the prevention of post hepatectomized Liver injury and the improvement of postoperative mortality and morbidity.