Splenectomy and risk of hepatocellular carcinoma

Hypersplenism is a common complication of cirrhosis that is associated with significant impairment to patients' life quality. Splenectomy is often employed in clinical settings as a treatment for hypersplenism. While splenectomy is carried out for the purposes of alleviating hypersplenism-related adverse outcomes like thrombocytopenia or anaemia, studies have suggested alterations in the immune status, hemodynamics, and intestinal microbiota of patients following splenectomy, which may potentially influence the onset and progression of hepatocellular carcinoma (HCC). Additionally, patients have been found to face new health risks post-splenectomy, including infections and thrombosis, which could adversely impact their overall health and potentially increase the risk of HCC. Despite these findings, there is currently no consensus on whether splenectomy affects the risk of postoperative HCC in cirrhotic patients. This review synthesizes the pertinent literature on the incidence of HCC following splenectomy, with an emphasis on current evidence related to its physiology, pathophysiology, and epidemiology. Concepts such as immune status, hemodynamics changes, and intestinal microbiota in post-splenectomy patients are explored, in hopes that it can inform more individualized treatment approaches for patients.