Published online Oct 21, 2018. doi: 10.3748/wjg.v24.i39.4499
Peer-review started: August 8, 2018
First decision: August 30, 2018
Revised: September 6, 2018
Accepted: October 5, 2018
Article in press: October 5, 2018
Published online: October 21, 2018
Patients with portal hypertension (PH) still have higher re-bleeding rates and mortality after splenectomy plus pericardial devascularisation. We simplified splenectomy plus traditional pericardial devascularisation (STPD) and put forward splenectomy plus simplified pericardial devascularisation (SSPD), whose initial curative effects have been verified, but its long-term survival effects are not clear. Therefore, we need to identify the best postoperative treatment to improve the prognosis of these patients, and a determination of the underlying influencing factors is useful for estimating outcomes and determining the appropriate treatments.
SSPD achieves or surpasses the long-term survival outcome of STPD and is worthy of clinical promotion and application. In clinical practice, males and older patients, patients with longer operative time, patients with higher Comprehensive Complication Index (CCI), alanine transaminase (ALT) and albumin-bilirubin (ALBI) scores at admission, patients with larger amounts of intraoperative bleeding and patients with longer postoperative exhaust time should receive more attention.
The main aim of the retrospective research was to assess the postoperative survival rates of PH patients and identify the clinical efficacy of SSPD. Factors influencing survival and nomograms were also identified.
Five hundred fifty-seven (53.30%) patients were successfully followed. We performed a Kaplan-Meier analysis to construct survival curves. We also applied log-rank test to verify the significance of difference in survival rates. The risk factors were estimated using a univariate Cox regression analysis. A multivariate Cox regression analysis was used to estimate the relative risk and to identify independent prognostic factors. The “rms” R library was used to construct nomograms.
Five hundred and fifty-seven (53.30%) patients were successfully followed; 93 (16.70%) patients died, of whom 42 (7.54%) patients died due to bleeding. Postoperative bleeding was observed in 84 (15.10%) patients. There was no significant difference between SSPD and STPD in 5- and 10-year overall survival (OS), disease-specific survival (DSS) and bleeding-free survival (BFS) rates. Age, operative time, ALT level and the ALBI score were independent prognostic factors for OS. Male sex, age, intraoperative blood loss and time to the first flatus were independent prognostic factors for BFS. CCI and age were independent prognostic factors for DSS. Nomograms were established and were better at predicting 1-, 3-, and 5-year OS and BFS rates.
SSPD achieves or surpasses the long-term survival outcomes of STPD, which is worthy of clinical promotion and application. In clinical practice, males, older patients, patients with longer operative time, patients with higher CCI scores, ALT levels and ALBI scores at admission, and patients with larger amounts of intraoperative bleeding and longer postoperative exhaust time should receive more attention. Nomograms are better in predicting prognosis according to individual patient characteristics.
In the future, the long-term survival of patients with PH undergoing SSPD should be assessed in large-scale prospective studies.