Background : Hepatocellular carcinoma (HCC) frequently occurs in cirrhotic patients with concurrent hypersplenism, posing challenges in their management.

Methods : This review article explores the indications of synchronous splenectomy for HCC with hypersplenism due to cirrhosis.

Results : Hypersplenism in cirrhosis leads to thrombocytopenia, leukopenia, and erythrocytopenia, impacting interventions. Synchronous splenectomy offers potential benefits. It addresses hypersplenism-related complications, improving platelet count and coagulation function, reducing bleeding risk and improving hemostasis. Splenectomy also alleviates hypersplenism-related symptoms, enhancing patients’ quality of life. Additionally, it aids surgical management by providing better liver exposure, facilitating tumor identification and resection, resulting in improved surgical outcomes and reduced bleeding. Moreover, splenectomy may have immunomodulatory effects. It counteracts the immunosuppressive influence of an enlarged spleen, potentially enhancing tumor control and improving long-term outcomes. However, patient characteristics and careful assessment guide splenectomy decisions. Factors include cirrhosis severity, portal hypertension, comorbidities, and overall health. Evaluation of potential risks and complications, such as infection and thrombosis, is also necessary.

Conclusions : In conclusion, synchronous splenectomy is considered for HCC with hypersplenism due to cirrhosis. It addresses complications, aids surgical management, and potentially modulates the immune response. Individual patient assessment and further research are needed to establish clear indications, refine protocols, and determine long-term outcomes of splenectomy in HCC treatment.