Prognosis after splenectomy plus pericardial devascularization vs transjugular intrahepatic portosystemic shunt for esophagogastric variceal bleeding

doi:10.4240/wjgs.v15.i8.1641

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World Journal of Gastrointestinal Surgery

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

World J Gastrointest Surg. Aug 27, 2023; 15(8): 1641-1651
Published online Aug 27, 2023. doi: 10.4240/wjgs.v15.i8.1641

Table 1 Baseline features of the study population

Characteristic	Before PSM			After PSM
Characteristic	SPD group	TIPS group	P value	SPD group	TIPS group	P value
Age, yr	44.14 ± 10.64	49.57 ± 11.24	< 0.001	46.41 ± 10.81	47.16 ± 10.95	0.65
Male, n (%)	121 (74.7)	105 (67.3)	0.15	64 (71.1)	60 (66.7)	0.520
Bleeding history, mo	12.70 ± 24.19	12.83 ± 21.95	0.961	13.64 ± 26.76	13.6 ± 22.62	0.99
Spleen length, cm	20.121 ± 4.49	19.27 ± 4.05	0.08	19.86 ± 4.47	18.85 ± 3.57	0.10
Spleen thickness, cm	6.47 ± 1.43	6.20 ± 1.42	0.09	6.31 ± 1.29	6.05 ± 1.07	0.14
TB, μmol/L	22.81 ± 9.93	22.18 ± 10.22	0.58	23.68 ± 10.60	21.99 ± 9.65	0.26
ALT, IU/L	34.561 ± 27.68	32.08 ± 35.49	0.49	29.81 ± 19.33	29.34 ± 15.25	0.86
AST, IU/L	40.651 ± 29.05	41.218 ± 35.80	0.88	36.37 ± 22.78	37.32 ± 18.09	0.76
ALB, g/L	37.71 ± 5.28	33.13 ± 6.19	< 0.001	36.35 ± 4.58	35.46 ± 5.15	0.22
A/G	1.311 ± 0.29	1.52 ± 3.40	0.45	1.31 ± 0.27	1.28 ± 0.29	0.58
ALP, IU/L	87.10 ± 39.98	85.08 ± 52.93	0.70	86.42 ± 37.50	86.93 ± 57.34	0.94
GGT, IU/L	50.13 ± 59.94	49.26 ± 61.59	0.90	53.35 ± 71.03	49.14 ± 63.91	0.68
BUN, mmol/L	6.038 ± 7.87	5.89 ± 2.76	0.82	6.48 ± 10.44	5.56 ± 2.00	0.42
CREA, μmol/L	72.92 ± 17.01	73.02 ± 18.40	0.96	73.20 ± 18.54	69.36 ± 14.59	0.13
HGB, g/L	99.74 ± 27.85	84.38 ± 23.18	< 0.001	94.42 ± 30.02	91.07 ± 23.76	0.41
RBC, × 10¹²/L	3.71 ± 0.82	3.06 ± 0.79	< 0.001	3.46 ± 0.81	3.39 ± 0.79	0.54
PLT, × 10⁹/L	51.85 ± 43.11	55.13 ± 37.11	0.47	50.76 ± 45.62	52.86 ± 24.49	0.70
WBC, × 10⁹/L	3.68 ± 3.85	3.59 ± 3.93	0.83	3.10 ± 2.56	3.38 ± 2.26	0.43
PT, s	14.67 ± 3.79	14.76 ± 2.08	0.79	14.38 ± 1.95	14.21 ± 1.75	0.54
INR	1.27 ± 0.17	1.32 ± 0.19	0.02	1.28 ± 0.17	1.27 ± 0.15	0.46
HBV-DNA Positive	80 (49.4)	81 (51.9)	0.65	47 (52.2)	48 (53.3)	0.88
Child-Pugh classification, n (%)			0.17			1.00
A	89 (54.9)	75 (48.1)		49 (54.4)	49 (54.4)
B	73 (45.1)	81 (51.9)		41 (45.6)	41 (45.6)
Severe EGV, n (%)	131 (80.9)	124 (79.5)	0.78	73 (81.1)	74 (82.2)	1.00

SPD: Splenectomy plus pericardial devascularization; TIPS: Transjugular intrahepatic portosystemic shunt; TB: Total bilirubin; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; ALB: Albumin; A/G: Albumin/globulin; ALP: Alkaline phosphatase; GGT: Gamma-glutamyl transpeptidase; HGB: Hemoglobin; RBC: Red blood cell count; WBC: White blood cell count; PLT: Platelets; PT: Prothrombin time; INR: International normalized ratio; HBV: Hepatitis B virus; EGV: Esophagogastric varices; PSM: Propensity score-matched analysis.

Table 2 Univariate and multivariate Cox regression analyses of factors associated with death

Variable	Univariable analysis		Multivariable analysis
	HR (95%CI)	P value¹	HR (95%CI)	P value
Treatment strategy (SPD vs TIPS)	0.43 (0.24-0.78)	0.005	0.47 (0.25-0.90)	0.02
Age, per 1-year increase	1.04 (1.02-1.07)	0.001	1.03 (1.01-1.06)	0.02
TB, per 1 μmol/L increase	1.03 (1.01-1.06)	0.01
ALB, per 1 g/L increase	0.94 (0.91-0.98)	0.004
A/G, per 1 increase	0.06 (0.02-0.18)	< 0.001	0.11 (0.03-0.48)	0.003
ALP, per 1 IU/L increase	1.01 (1.00-1.01)	< 0.001
GGT, per 1 IU/L increase	1.003 (1.00-1.01)	0.03
PT, per 1 s increase	1.07 (1.02-1.12)	0.004	1.09 (1.02-1.16)	0.01
INR, per 1 increase	6.38 (1.68-24.24)	0.006
HBV-DNA (Positive vs negative)	1.78 (1.00-3.15)	0.05
Child-Pugh classification (B vs A)	1.83 (1.07-3.15)	0.03

¹Variables that were found significant at P < 0.1 in the univariable analyses were entered into the multivariable analyses. SPD: Splenectomy plus pericardial devascularization; TIPS: Transjugular intrahepatic portosystemic shunt; TB: Total bilirubin; ALB: Albumin; A/G: Albumin/globulin; ALP: Alkaline phosphatase; GGT: Gamma-glutamyl transpeptidase; PT: Prothrombin time; INR: International normalized ratio; HBV: Hepatitis B virus.

Table 3 Proportions of 1-, 3-, and 5-year cumulative variceal rebleeding, abnormal liver function, and hepatocellular carcinoma in the two groups before and after propensity score matching, %

Outcome/Time	Before PSM			After PSM
Outcome/Time	SPD group	TIPS group	P value¹	SPD group	TIPS group	P value¹
Variceal rebleeding
1-yr	8.60	20.50	0.001	7.80	11.10	0.09
3-yr	19.10	34.60		15.65	27.80
5-yr	24.10	37.80		23.30	31.10
Abnormal liver function
1-yr	13.60	48.70	< 0.001	13.30	46.70	< 0.001
3-yr	19.80	57.70		18.90	53.30
5-yr	22.80	60.30		20.00	56.70
Hepatocellular carcinoma
1-yr	2.50	3.80	0.03	2.20	4.40	0.02
3-yr	3.70	9.00		2.20	10.00
5-yr	4.90	11.50		2.20	12.20

¹Log-rank test was used to compare the differences between the two groups for each outcome event. SPD: Splenectomy plus pericardial devascularization; TIPS: Transjugular intrahepatic portosystemic shunt; PSM: Propensity score-matched analysis.

Table 4 Multivariate Cox regression analysis of factors associated with variceal rebleeding, abnormal liver function, and hepatocellular carcinoma

Outcome/Variable	HR (95%CI)	P value
Variceal rebleeding
Treatment strategy (SPD vs TIPS)	0.58 (0.37-0.89)	0.01
GGT, per 1 IU/L increase	1.005 (1.001-1.008)	0.01
HGB, per 1 g/L increase	0.99 (0.98-1.00)	0.01
Abnormal liver function
Treatment Strategy (SPD vs TIPS)	0.26 (0.17-0.39)	< 0.001
TB, per 1 μmol/L increase	1.03 (1.02-1.05)	< 0.001
ALP, per 1 IU/L increase	1.004 (1.000-1.007)	0.03
PT, per 1 s increase	1.06 (1.00-1.13)	0.045
Hepatocellular carcinoma
Treatment Strategy (SPD vs TIPS)	0.43 (0.20-0.93)	0.03
TB, per 1 μmol/L increase	1.03 (1.00-1.07)	0.045
ALP, per 1 IU/L increase	1.006 (1.000-1.012)	0.043

SPD: Splenectomy plus pericardial devascularization; TIPS: Transjugular intrahepatic portosystemic shunt; TB: Total bilirubin; ALB: albumin; ALP: Alkaline phosphatase; GGT: Gamma-glutamyl transpeptidase; PT: Prothrombin time; HGB: Hemoglobin.

Table 5 Comparison of postoperative hospital days and number of reoperations and adverse events between the two groups

Variable	SPD group	TIPS group	P value
Postoperative hospital stay, days	9.5 ± 3.4	6.6 ± 3.9	< 0.001
Reoperation, times	5	92	< 0.001
In-hospital mortality	1	1	0.98
The 90-d mortality	1	4	0.21
The 30-d readmission	1	22	< 0.001
Occurrence of hepatic encephalopathy	1	25	< 0.001

SPD: Splenectomy plus pericardial devascularization; TIPS: Transjugular intrahepatic portosystemic shunt.

Citation: Qi WL, Wen J, Wen TF, Peng W, Zhang XY, Shen JY, Li X, Li C. Prognosis after splenectomy plus pericardial devascularization vs transjugular intrahepatic portosystemic shunt for esophagogastric variceal bleeding. World J Gastrointest Surg 2023; 15(8): 1641-1651
URL: https://www.wjgnet.com/1948-9366/full/v15/i8/1641.htm
DOI: https://dx.doi.org/10.4240/wjgs.v15.i8.1641