This study aimed to clarify the clinical features of patients in whom nutritional intervention should be initiated. Of the 408 patients with first-episode liver cancer diagnosed between 2005 and 2021, patients were Child-Pugh A and within the Milan criteria who were evaluated for muscle volume loss (MVL) by Psoas muscle index (PMI) on CT data, esophagogastric varices (EGV) by upper gastrointestinal endoscopy and curative treatment. Liver function was evaluated by modified albumin-bilirubin grade (mALBI), and patients with portal hypertension (PHT) were defined as F2 or higher/treatment history+. BTR less than 4.4 was defined as having amino acid imbalance (AAI), and overall survival was analyzed retrospectively. Patients with PHT and MVL had a higher rate of AAI complications than those without PHT (75.0% vs. 32.9%, p = 0.009). (MST 79.1-91.3 months vs. 140.7 months, p = 0.003). 75 years or older (HR 2.42), mALBI < 2b (HR 1.81), MVL (HR 1.55), PHT (HR 1.672), (respectively p < 0.05) were prognostic factors. ALBI predicting AAI was -2.586 (AUC 0.789). Nutritional intervention should be aggressively implemented to prevent progression to MVL, because AAI has already begun to occur not only LC with PHT even in Child-Pugh A but also those show a worsening trend from mALBI 1 to 2a.

Splenectomies are widely performed using a laparoscopic approach, but there are no reports of a left-open thoracoabdominal approach (left thoracotomy with laparotomy).

As of 2021, we have performed splenectomies using a left-open thoracoabdominal (Thoraco group, n = 11) or laparoscopic (Laparo group, n = 10) approach. Background and operation data for each of the patients were analyzed. The Thoraco group comprised 4 men and 7 women (median age 71) with splenic malignancy (n = 5), idiopathic portal hypertension (n = 1), Epstein-Barr virus-associated inflammatory pseudotumor (n = 1), epithelial cyst (n = 1), splenic arteriovenous fistula (n = 1), hypersplenism (n = 1), and left-sided portal hypertension (n = 1). The estimated median volume of the spleen was 697 ml. The Laparo group comprised 6 men and 4 women (median age 71) with splenic malignancy (n = 5), idiopathic thrombocytopenic purpura (n = 3), hemorrhagic hamartoma (n = 1), and hereditary spherocytosis (n = 1). The estimated median volume of the spleen was 213 ml.

The backgrounds of both groups were similar except the Thoraco group had a larger preoperative estimated spleen volume (697 vs 213 ml, p < 0.05); the Thoraco group also had a shorter operation time (180 vs 304 min, p < 0.01), and fewer pancreatic fistulas (n = 1 vs n = 5, p < 0.05).

In limited cases, splenectomy was safely performed using a left-open thoracoabdominal approach.