Expectations for partial splenic arterial embolization simultaneous transcatheter arterial chemoembolization for hepatocellular carcinoma

Abstract

Hepatocellular carcinoma (HCC) is frequently complicated by cirrhosis, and it is not unusual for treatment options to be limited as a result of pancytopenia due to hypersplenism. Partial splenic embolization (PSE) has been performed for thrombocytopenia resulting from hypersplenism. However, the safety and efficacy of concurrent transcatheter arterial chemoembolization (TACE) with PSE for HCC remain unclear. Thrombocytopenia has been improved and treatment continued using concurrent PSE. In addition, hepatic functional reserve could be maintained even after treatment for HCC. Concurrent TACE and PSE for HCC with thrombocytopenia can be expected to help maintain hepatic reserve, and it may contribute to improving the prognosis of HCC. Hence, PSE could lead to an asplenic state. The appearance of Howell-Jolly bodies on a peripheral blood smear is reported useful for assessing splenic function. The appearance of Howell-Jolly bodies is associated with an increased risk for post splenectomy sepsis/overwhelming postsplenectomy infection in patients with reduced splenic function. These bodies are frequently observed in peripheral erythrocytes after PSE, and when they are present, it is appropriate to administer pneumococcal vaccine to prevent severe infection. The expectations for PSE combined with TACE for the treatment of HCC associated with cirrhosis are reviewed.

Keywords

Hepatic functional reserve / hepatocellular carcinoma / partial splenic embolization / thrombocytopenia / transcatheter arterial chemoembolization

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