Background: Hepatic splenosis (HS) is a rare para-physiological condition resulting from the ectopic implantation of splenic tissue, most commonly following traumatic or surgical splenectomy. Its radiological features can mimic those of hepatocellular carcinoma (HCC), potentially leading to misdiagnosis and unnecessary invasive procedures, such as biopsies or liver resection. Methods: A literature review was conducted using the PubMed database to identify all reported cases of HS. Case Presentation: We report the case of a 52-year-old male with an incidental finding of a liver lesion in segment V, initially suspected to be HCC, and a history of post-traumatic splenectomy. The patient had no history of underlying liver disease. Due to the lesion’s superficial location, a biopsy was not performed because of the risk of tumor rupture with subsequent bleeding or peritoneal seeding. Consequently, the patient underwent upfront laparoscopic anatomic segmentectomy of segment V. Final pathology revealed a diagnosis of intrahepatic splenosis. Conclusions: HS should be considered in the differential diagnosis of liver lesions in patients with a history of splenectomy but no underlying liver disease, particularly when imaging shows features suggestive of HCC, such as arterial phase hyperenhancement and portal venous washout. Awareness of this entity may prevent unnecessary invasive interventions and guide appropriate patient management.

Background: Postoperative serum ALT levels are one of the most frequently used marker to detect liver tissue damage following liver resection. The aim of this study was to evaluate if minimally invasive liver surgery (MILS) may result in less hepatic injury than open hepatectomy by assessing the differences of postoperative ALT levels. Methods: Patients who underwent MILS between 2009 and 2019 at our unit were included and compared with open liver resections. Median ALT levels was measured on postoperative day (POD) 1, 3 and 5. Postoperative peak transaminase (PPT) of ALT was determined on POD 1. The stabilized inverse probability treatment weighing (SIPTW) process was used to balance the two groups. A multivariable logistic regression analysis was used to analyze factors associated with high PPT. Results: After SIPTW, 292 MILS were compared with 159 open resections. Median ALT levels on POD 1, 3 and 5 were significantly higher in the open group than in the MILS group (301 vs. 187, p = 0.002; 180 vs. 121, p < 0.0001; 104 vs. 60, p < 0.0001; respectively). At the multivariable logistic regression analysis, MILS showed a protective effect for high PPT. Conclusions: MILS was associated with significantly lower postoperative ALT levels compared with open liver resections. MILS showed a protective effect for high PPT.

Introduction: The correct risk stratification is the key to achieving a low postoperative mortality after liver resection for HCC, including the evaluation of liver function and the presence of portal hypertension. The aim of this study was to evaluate the accuracy of Hepatic Venous-Portal pressure Gradients (HVPG), Indocyanine Green retention test (ICG-R15) and Liver Stiffness (LSM) in predicting the risk of post-hepatectomy liver failure and major postoperative complications in selected cirrhotic patients. Methods: A multicenter prospective study was designed, including consecutive cirrhotic patients undergoing liver resection for HCC. The predictive ability of HVPG, LSM and ICG-R15 was tested by evaluating the Area Under the ROC Curves. Results: Ninety-eight cirrhotic patients undergoing liver resection for HCC were included. Twelve patients (12.2%) developed at least one of the complications included within the composite endpoint. Three patients (3%) developed post-hepatectomy liver failure (PHLF) (one graded A and two graded C according to the International Study Group of Liver Surgery), five patients (5.1%) developed large ascites, five patients (5.1%) developed severe postoperative complications, two patients (2%) died during the hospital stay (PHLF). HVPG showed the higher AUC (0.778, 95% CI 0.641- 0.898; p < 0.001), followed by LSM (0.669, 95% CI 0.471–0.847; p = 0.097) and ICG-R15 (0.593, 95% CI 0.378–0.788; p = 0.615). Conclusions: In our cohort of selected HCC patients undergoing elective surgery, the predictive ability of HVPG on developing a composite endpoint including PHLF, in-hospital mortality, large postoperative ascites and major postoperative complications is higher than LSM and ICG-R15.