Skip to main content
SpringerLink
Log in

Laparoscopic splenectomy with peginterferon and ribavirin therapy for patients with hepatitis C virus cirrhosis and hypersplenism

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

This study aimed to evaluate whether laparoscopic splenectomy (Lap-Sp) contributes to the completion and curability of combined peginterferon and ribavirin (peg-IFN + RIB) therapy for cirrhotic patients with pancytopenia due to hypersplenism.

Methods

From December 2004 to September 2007, 21 patients underwent Lap-Sp before treatment with peg-IFN + RIB. All the patients were Child-Pugh class A or B with a mean platelet count of 5.7 × 104/mm3 and a mean leukocyte count of 2,830/mm3. The hepatitis C virus (HCV) genotype was 1b for 18 patients and 2b for 3 patients. Of the 21 patients, 17 had a viral load exceeding 100 KIU/ml, and 4 had a load of less than 100 KIU/ml.

Results

All the patients underwent Lap-Sp without severe complications. The average hospital stay was 12.7 days (range, 6–23 days). Platelet counts increased from a mean of 5.7 ± 2.2 × 104/mm3 preoperatively to 19.6 ± 7.6 × 104/mm3 postoperatively and remained above 7.0 × 104/mm3 during the subsequent peg-IFN + RIB therapy. The full course of therapy was completed for nine patients, with five obtaining a sustained virologic response and one obtaining a biologic response. The five patients who obtained a sustained virologic response had either HCV type 2b or 1b with a low viral load (<100 KIU). At this writing, treatment is ongoing for the remaining 12 patients.

Conclusions

Laparoscopic splenectomy allows patients with HCV cirrhosis and hypersplenism to receive full-dose peg-IFN + RIB therapy. Patients with HCV, genotype 2 or 1b and a low viral load, and hypersplenism may be good candidates for Lap-Sp.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Fried MW, Shiffman ML, Reddy KR, Smith C, Marinos G, Goncales FL Jr, Haussinger D, Diago M, Carosi G, Dhumeaux D, Craxi A, Lin A, Hoffman J, Yu J (2002) Peginterferon alfa-2a plus ribavirin for chronic hepatitis C virus infection. N Engl J Med 347:975–982

    Article  CAS  PubMed  Google Scholar 

  2. Yoshida H, Shiratori Y, Moriyama M, Arakawa Y, Ide T, Sata M, Inoue O, Yano M, Tanaka M, Fujiyama S, Nishiguchi S, Kuroki T, Imazeki F, Yokosuka O, Kinoyama S, Yamada G, Omata M (1999) Interferon therapy reduces the risk for hepatocellular carcinoma: national surveillance program of cirrhotic and noncirrhotic patients with chronic hepatitis C in Japan. Ann Intern Med 131:174–181

    CAS  PubMed  Google Scholar 

  3. Bruno S, Stroffolini T, Colombo M, Bollani S, Benvegnù L, Mazzella G, Ascione A, Santantonio T, Piccinino F, Andreone P, Mangia A, Gaeta GB, Persico M, Fagiuoli S, Almasio PL, Italian Association of the Study of the Liver Disease (AISF) (2007) Sustained virological response to interferon-alpha is associated with improved outcome in HCV-related cirrhosis: a retrospective study. Hepatology 45:579–587

    Article  CAS  PubMed  Google Scholar 

  4. Ikeda K, Saitoh S, Arase Y, Chayama K, Suzuki Y, Kobayashi M, Tsubota A, Nakamura I, Murashima N, Kumada H, Kawanishi M (1999) Effect of interferon therapy on hepatocellular carcinogenesis in patients with chronic hepatitis type C: a long-term observation study of 1, 643 patients using statistical bias correction with proportional hazard analysis. Hepatology 29:1124–1130

    Article  CAS  PubMed  Google Scholar 

  5. Russo MW, Fried MW (2003) Side effects of therapy for chronic hepatitis C (review). Gastroenterology 123:1711–1719

    Article  Google Scholar 

  6. Renault PF, Hoofnagle JH (1989) Side effects of alpha interferon. Semin Liver Dis 9:273–277

    Article  CAS  PubMed  Google Scholar 

  7. Hoofnagle JH (1991) Thrombocytopenia during interferon alfa therapy. JAMA 266:849

    Article  CAS  PubMed  Google Scholar 

  8. Peck-Radosavljevic M, Wichlas M, Pidlich J, Sims P, Meng G, Zacherl J, Garg S, Datz C, Gangl A, Ferenci P (1998) Blunted thrombopoietin response to interferon alfa-induced thrombocytopenia during treatment for hepatitis C. Hepatology 28:1424–1429

    Article  CAS  PubMed  Google Scholar 

  9. Soza A, Everhart JE, Ghany MG, Doo E, Heller T, Promrat K, Park Y, Liang TJ, Hoofnagle JH (2002) Neutropenia during combination therapy of interferon alfa and ribavirin for chronic hepatitis C. Hepatology 36:1273–1279

    Article  CAS  PubMed  Google Scholar 

  10. Hashizume M, Sugimachi K, Kitano S, Shimada M, Baba H, Ueno K, Ohta M, Tomikawa M (1994) Laparoscopic splenectomy. Am J Surg 167:611–614

    Article  CAS  PubMed  Google Scholar 

  11. Hashizume M, Tomikawa M, Akahoshi T, Tanoue K, Gotoh N, Konishi K, Okita K, Tsutsumi N, Shimabukuro R, Yamaguchi S, Sugimachi K (2002) Laparoscopic splenectomy for portal hypertension. Hepatogastroenterology 49:847–852

    PubMed  Google Scholar 

  12. Kercher KW, Carbonell AM, Heniford BT, Matthews BD, Cunningham DM, Reindollar RW (2004) Laparoscopic splenectomy reverses thrombocytopenia in patients with hepatitis C cirrhosis and portal hypertension. J Gastrointest Surg 8:120–126

    Article  PubMed  Google Scholar 

  13. Ichida F, Tsuji T, Omata M (1996) New Inuyama classification: new criteria for histological assessment of chronic hepatitis. Int Hepatol Commun 6:112–119

    Article  Google Scholar 

  14. Winslow ER, Brunt LM, Drebin JA, Soper NJ, Klingensmith ME (2002) Portal vein thrombosis after splenectomy. Am J Surg 184:631–635

    Article  PubMed  Google Scholar 

  15. Hassn AM, Al-Fallouji MA, Ouf TI, Saad R (2000) Portal vein thrombosis following splenectomy. Br J Surg 87:362–373

    Article  PubMed  Google Scholar 

  16. Chaffanjon PC, Brichon PY, Ranchoup Y, Gressin R, Sotto JJ (1998) Portal vein thrombosis following splenectomy for hematologic disease: prospective study with Doppler color flow imaging. World J Surg 22:1082–1086

    Article  CAS  PubMed  Google Scholar 

  17. Sangro B, Bilbao I, Herrero I, Corella C, Longo J, Beloqui O, Ruiz J, Zozaya JM, Quiroga J, Prieto J (1993) Partial splenic embolization for the treatment of hypersplenism in cirrhosis. Hepatology 18:309–314

    Article  CAS  PubMed  Google Scholar 

  18. Alwmark A, Bengmark S, Gullstrand P, Joelsson B, Lundequist A, Owman T (1982) Evaluation of splenic embolization in patients with portal hypertension and hypersplenism. Ann Surg 196:518–524

    Article  CAS  PubMed  Google Scholar 

  19. Hong YC, Wu HK, Yang AD (1999) Evaluation of partial splenic embolization in patients with hypersplenism in cirrhosis. Chin J Radiol 24:233–237

    Google Scholar 

  20. Noguchi H, Hirai K, Aoki Y, Sakata K, Tanikawa K (1995) Changes in platelet kinetics after a partial splenic arterial embolization in cirrhotic patients with hypersplenism. Hepatology 22:1682–1688

    Article  CAS  PubMed  Google Scholar 

  21. Vujic I, Lauver JW (1981) Severe complications from partial splenic embolization in patients with liver failure. Br J Radiol 54:492–495

    Article  CAS  PubMed  Google Scholar 

  22. Kato M, Shimohashi N, Ouchi J, Yoshida K, Tanabe Y, Takenaka K, Nakamuta M (2005) Partial splenic embolization facilitates completion of interferon therapy in patients with chronic HCV infection and hypersplenism. J Gastroenterol 40:1076–1077

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Fukuoka City Hospital, 13-1 of Yoshizukahonmachi, Hakata-ku, Fukuoka, 812-0046, Japan

    Tomohiko Akahoshi, Morimasa Tomikawa, Daisuke Korenaga & Kenji Takenaka

  2. Department of Surgery, National Kyushu Medical Center, 1-8-1 Jigyohama Chuo-ku, Fukuoka, 810-8563, Japan

    Koji Ikejiri & Motonori Saku

Authors
  1. Tomohiko Akahoshi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Morimasa Tomikawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Daisuke Korenaga
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Koji Ikejiri
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Motonori Saku
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kenji Takenaka
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tomohiko Akahoshi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Akahoshi, T., Tomikawa, M., Korenaga, D. et al. Laparoscopic splenectomy with peginterferon and ribavirin therapy for patients with hepatitis C virus cirrhosis and hypersplenism. Surg Endosc 24, 680–685 (2010). https://doi.org/10.1007/s00464-009-0653-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-009-0653-6

Keywords

Search

Navigation