Simultaneous Splenectomy and Partial Hepatectomy for Hepatocellular Carcinoma in a Cirrhotic Patient With Severe Hypersplenism: A Case Report

Hepatocellular carcinoma (HCC) often arises in the setting of liver cirrhosis and portal hypertension, which complicates curative treatment strategies. Although liver transplantation represents the gold standard treatment for HCC in cirrhotic patients, severe organ shortage, particularly in Asian countries including Japan, limits its availability. Hypersplenism associated with massive splenomegaly frequently results in severe thrombocytopenia, limiting the feasibility of surgical resection. We report the case of a 55-year-old man with alcohol-related cirrhosis, portal hypertension, and marked pancytopenia who was diagnosed with primary HCC. Liver transplantation was discussed, but was not feasible due to the absence of potential living donors and the prolonged waiting time for deceased donor transplantation in Japan. Imaging revealed a 2-cm hypervascular tumor in segment five of the liver and massive splenomegaly with multiple collateral vessels. Given profound thrombocytopenia (platelet count 32,000/µL), simultaneous splenectomy and partial hepatectomy were performed. The surgery proceeded safely despite advanced cirrhosis (Child-Pugh B, Indocyanine green retention test (ICG-R15) 36%), with perioperative transfusion support. Postoperatively, platelet counts improved rapidly, peaking at 310,000/µL, and liver function stabilized without major complications. Histopathology confirmed moderately differentiated HCC (pT2N0M0, stage II). At the three-month follow-up, no recurrence or portal vein thrombosis was detected, and the patient resumed normal activities. This case highlights the potential role of concomitant splenectomy in selected cirrhotic patients with hypersplenism who are not candidates for liver transplantation, enabling safe hepatic resection and possibly promoting hepatic regeneration through hematologic and hemodynamic mechanisms. However, careful patient selection and vigilant management of splenectomy-related risks remain essential.