Simultaneous splenectomy improving the outcomes of patients with hepatocellular carcinoma, cirrhosis and portal hypertension treated with hepatectomy
Abstract Aims Patients with cirrhosis and clinically significant portal hypertension (CSPH) usually have concomitant secondary hypersplenism, and splenectomy (Spx) is an option for treating these patients in the Asia‐Pacific region. CSPH is the most important risk factor for postoperative liver dysf...
| Main Authors: | , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2022-09-01
|
| Series: | Portal Hypertension & Cirrhosis |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/poh2.29 |
| _version_ | 1828065475176693760 |
|---|---|
| author | Fuchen Liu Xinggang Guo Wenli Zhang Minghao Zou Jian Huang Wei Dong Jinmin Zhang Xiuli Zhu Zeya Pan Wan Yee Lau Weiping Zhou Hui Liu |
| author_facet | Fuchen Liu Xinggang Guo Wenli Zhang Minghao Zou Jian Huang Wei Dong Jinmin Zhang Xiuli Zhu Zeya Pan Wan Yee Lau Weiping Zhou Hui Liu |
| author_sort | Fuchen Liu |
| collection | DOAJ |
| description | Abstract Aims Patients with cirrhosis and clinically significant portal hypertension (CSPH) usually have concomitant secondary hypersplenism, and splenectomy (Spx) is an option for treating these patients in the Asia‐Pacific region. CSPH is the most important risk factor for postoperative liver dysfunction (PLD) in patients with hepatocellular carcinoma (HCC) and cirrhosis undergoing liver resection. However, the impact of simultaneous Spx and hepatectomy in patients with HCC and CSPH remains unclear. In this study, we aimed to determine the impact of simultaneous Spx on the posthepatectomy outcomes in these patients. Methods This study included 691 consecutive patients with hepatitis B virus‐related HCC, cirrhosis, and CSPH. These included 565 patients who underwent hepatectomy only (non‐Spx group) and 126 who underwent simultaneous hepatectomy and splenectomy (Spx group). We analyzed the effect of 25 preoperative and 5 intraoperative factors on postoperative outcomes using logistic regression. To overcome any possible selection bias, confounders were balanced by propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) analyses, and subgroup analyses were performed within the PSM‐matched groups. Results Logistic regression analyses revealed that Spx was an independent protective factor for severe postoperative liver dysfunction (SPLD; odds ratio [OR] = 0.22, 95% confidence interval [CI]: 0.11–0.43, p < 0.001) and 90‐day SPLD‐related mortality (OR = 0.21, 95% CI: 0.06–0.55, p = 0.004), respectively. Spx was also independently associated with a higher overall survival rate (hazard ratio = 0.63, 95% CI = 0.47–0.85, p = 0.002) based on Cox regression analysis. PSM and IPTW models showed that the benefit of Spx was also consistent across the major and minor hepatectomy subgroups examined. Conclusion Simultaneous Spx improved the outcomes of patients with HCC, cirrhosis, and CSPH treated with hepatectomy, including patients who underwent major and minor hepatectomies. |
| first_indexed | 2024-04-10T23:14:58Z |
| format | Article |
| id | doaj.art-e78f58dbe78b4ad9bcad10d2c4ee1aee |
| institution | Directory Open Access Journal |
| issn | 2770-5846 |
| language | English |
| last_indexed | 2024-04-10T23:14:58Z |
| publishDate | 2022-09-01 |
| publisher | Wiley |
| record_format | Article |
| series | Portal Hypertension & Cirrhosis |
| spelling | doaj.art-e78f58dbe78b4ad9bcad10d2c4ee1aee2023-01-13T01:40:04ZengWileyPortal Hypertension & Cirrhosis2770-58462022-09-01129010010.1002/poh2.29Simultaneous splenectomy improving the outcomes of patients with hepatocellular carcinoma, cirrhosis and portal hypertension treated with hepatectomyFuchen Liu0Xinggang Guo1Wenli Zhang2Minghao Zou3Jian Huang4Wei Dong5Jinmin Zhang6Xiuli Zhu7Zeya Pan8Wan Yee Lau9Weiping Zhou10Hui Liu11The Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, The Third Affiliated Hospital The Second Military Medical University, Naval Medical University Shanghai ChinaThe Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, The Third Affiliated Hospital The Second Military Medical University, Naval Medical University Shanghai ChinaThe Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, The Third Affiliated Hospital The Second Military Medical University, Naval Medical University Shanghai ChinaThe Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, The Third Affiliated Hospital The Second Military Medical University, Naval Medical University Shanghai ChinaThe Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, The Third Affiliated Hospital The Second Military Medical University, Naval Medical University Shanghai ChinaThe Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, The Third Affiliated Hospital The Second Military Medical University, Naval Medical University Shanghai ChinaDepartment of Anesthesiology, Eastern Hepatobiliary Surgery Hospital, The Third Affiliated Hospital The Second Military Medical University, Naval Medical University Shanghai ChinaDepartment of Gastroenterology, Anhui Provincial Hospital University of Science and Technology of China Hefei Anhui ChinaThe Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, The Third Affiliated Hospital The Second Military Medical University, Naval Medical University Shanghai ChinaFaculty of Medicine The Chinese University of Hong Kong Shatin Hong Kong ChinaThe Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, The Third Affiliated Hospital The Second Military Medical University, Naval Medical University Shanghai ChinaThe Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, The Third Affiliated Hospital The Second Military Medical University, Naval Medical University Shanghai ChinaAbstract Aims Patients with cirrhosis and clinically significant portal hypertension (CSPH) usually have concomitant secondary hypersplenism, and splenectomy (Spx) is an option for treating these patients in the Asia‐Pacific region. CSPH is the most important risk factor for postoperative liver dysfunction (PLD) in patients with hepatocellular carcinoma (HCC) and cirrhosis undergoing liver resection. However, the impact of simultaneous Spx and hepatectomy in patients with HCC and CSPH remains unclear. In this study, we aimed to determine the impact of simultaneous Spx on the posthepatectomy outcomes in these patients. Methods This study included 691 consecutive patients with hepatitis B virus‐related HCC, cirrhosis, and CSPH. These included 565 patients who underwent hepatectomy only (non‐Spx group) and 126 who underwent simultaneous hepatectomy and splenectomy (Spx group). We analyzed the effect of 25 preoperative and 5 intraoperative factors on postoperative outcomes using logistic regression. To overcome any possible selection bias, confounders were balanced by propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) analyses, and subgroup analyses were performed within the PSM‐matched groups. Results Logistic regression analyses revealed that Spx was an independent protective factor for severe postoperative liver dysfunction (SPLD; odds ratio [OR] = 0.22, 95% confidence interval [CI]: 0.11–0.43, p < 0.001) and 90‐day SPLD‐related mortality (OR = 0.21, 95% CI: 0.06–0.55, p = 0.004), respectively. Spx was also independently associated with a higher overall survival rate (hazard ratio = 0.63, 95% CI = 0.47–0.85, p = 0.002) based on Cox regression analysis. PSM and IPTW models showed that the benefit of Spx was also consistent across the major and minor hepatectomy subgroups examined. Conclusion Simultaneous Spx improved the outcomes of patients with HCC, cirrhosis, and CSPH treated with hepatectomy, including patients who underwent major and minor hepatectomies.https://doi.org/10.1002/poh2.29clinically significant portal hypertensionHCChepatectomyposthepatectomy liver dysfunctionSplenectomy |
| spellingShingle | Fuchen Liu Xinggang Guo Wenli Zhang Minghao Zou Jian Huang Wei Dong Jinmin Zhang Xiuli Zhu Zeya Pan Wan Yee Lau Weiping Zhou Hui Liu Simultaneous splenectomy improving the outcomes of patients with hepatocellular carcinoma, cirrhosis and portal hypertension treated with hepatectomy Portal Hypertension & Cirrhosis clinically significant portal hypertension HCC hepatectomy posthepatectomy liver dysfunction Splenectomy |
| title | Simultaneous splenectomy improving the outcomes of patients with hepatocellular carcinoma, cirrhosis and portal hypertension treated with hepatectomy |
| title_full | Simultaneous splenectomy improving the outcomes of patients with hepatocellular carcinoma, cirrhosis and portal hypertension treated with hepatectomy |
| title_fullStr | Simultaneous splenectomy improving the outcomes of patients with hepatocellular carcinoma, cirrhosis and portal hypertension treated with hepatectomy |
| title_full_unstemmed | Simultaneous splenectomy improving the outcomes of patients with hepatocellular carcinoma, cirrhosis and portal hypertension treated with hepatectomy |
| title_short | Simultaneous splenectomy improving the outcomes of patients with hepatocellular carcinoma, cirrhosis and portal hypertension treated with hepatectomy |
| title_sort | simultaneous splenectomy improving the outcomes of patients with hepatocellular carcinoma cirrhosis and portal hypertension treated with hepatectomy |
| topic | clinically significant portal hypertension HCC hepatectomy posthepatectomy liver dysfunction Splenectomy |
| url | https://doi.org/10.1002/poh2.29 |
| work_keys_str_mv | AT fuchenliu simultaneoussplenectomyimprovingtheoutcomesofpatientswithhepatocellularcarcinomacirrhosisandportalhypertensiontreatedwithhepatectomy AT xinggangguo simultaneoussplenectomyimprovingtheoutcomesofpatientswithhepatocellularcarcinomacirrhosisandportalhypertensiontreatedwithhepatectomy AT wenlizhang simultaneoussplenectomyimprovingtheoutcomesofpatientswithhepatocellularcarcinomacirrhosisandportalhypertensiontreatedwithhepatectomy AT minghaozou simultaneoussplenectomyimprovingtheoutcomesofpatientswithhepatocellularcarcinomacirrhosisandportalhypertensiontreatedwithhepatectomy AT jianhuang simultaneoussplenectomyimprovingtheoutcomesofpatientswithhepatocellularcarcinomacirrhosisandportalhypertensiontreatedwithhepatectomy AT weidong simultaneoussplenectomyimprovingtheoutcomesofpatientswithhepatocellularcarcinomacirrhosisandportalhypertensiontreatedwithhepatectomy AT jinminzhang simultaneoussplenectomyimprovingtheoutcomesofpatientswithhepatocellularcarcinomacirrhosisandportalhypertensiontreatedwithhepatectomy AT xiulizhu simultaneoussplenectomyimprovingtheoutcomesofpatientswithhepatocellularcarcinomacirrhosisandportalhypertensiontreatedwithhepatectomy AT zeyapan simultaneoussplenectomyimprovingtheoutcomesofpatientswithhepatocellularcarcinomacirrhosisandportalhypertensiontreatedwithhepatectomy AT wanyeelau simultaneoussplenectomyimprovingtheoutcomesofpatientswithhepatocellularcarcinomacirrhosisandportalhypertensiontreatedwithhepatectomy AT weipingzhou simultaneoussplenectomyimprovingtheoutcomesofpatientswithhepatocellularcarcinomacirrhosisandportalhypertensiontreatedwithhepatectomy AT huiliu simultaneoussplenectomyimprovingtheoutcomesofpatientswithhepatocellularcarcinomacirrhosisandportalhypertensiontreatedwithhepatectomy |