Retrospective Cohort Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Aug 27, 2023; 15(8): 1641-1651
Published online Aug 27, 2023. doi: 10.4240/wjgs.v15.i8.1641
Prognosis after splenectomy plus pericardial devascularization vs transjugular intrahepatic portosystemic shunt for esophagogastric variceal bleeding
Wei-Li Qi, Jun Wen, Tian-Fu Wen, Wei Peng, Xiao-Yun Zhang, Jun-Yi Shen, Xiao Li, Chuan Li
Wei-Li Qi, Jun Wen, Tian-Fu Wen, Wei Peng, Xiao-Yun Zhang, Jun-Yi Shen, Chuan Li, Department of Liver Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Jun Wen, Section for HepatoPancreatoBiliary Surgery, Department of General Surgery, The Third People’s Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University & The Second Affiliated Hospital of Chengdu, Chongqing Medical University, Chengdu 610041, Sichuan Province, China
Xiao Li, Department of Interventional Therapy, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Xiao Li, Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100000, China
Author contributions: Wen TF, Li X, and Li C conceptualized and designed the study, and provided the study materials or patients; Wen TF provided administrative support; Qi WL, Wen J, Li C, Peng W, and Zhang XY collected and assembled the data; Qi WL, Wen J, and Shen JY performed data analysis and interpretation; all authors participated in manuscript writing and approved the final manuscript. Qi WL and Wen J contributed equally to this work.
Supported by the National Key R&D Program of China, No. 2022YFC2503701; the Science and Technological Supports Project of Sichuan Province, No. 2022YFS0255; and the National Natural Science Foundation of China, No. 81800449.
Institutional review board statement: The study was conducted in accordance with the Declaration of Helsinki (as revised in 2013). The study protocol was approved by the Ethics Committee on Biomedical Research, West China Hospital of Sichuan University (No. 2023-354).
Informed consent statement: The ethics committee approved the waiver of informed consent because the study was retrospective in nature.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement – checklist of items, and the manuscript was prepared and revised according to the STROBE Statement – checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chuan Li, MD, PhD, Associate Professor, Department of Liver Surgery, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu 610041, Sichuan Province, China. lichuan@scu.edu.cn
Received: March 20, 2023
Peer-review started: March 20, 2023
First decision: May 15, 2023
Revised: June 4, 2023
Accepted: June 26, 2023
Article in press: June 26, 2023
Published online: August 27, 2023
Processing time: 156 Days and 3.5 Hours
Abstract
BACKGROUND

Portal hypertension combined with esophagogastric variceal bleeding (EGVB) is a serious complication in patients with hepatitis B virus (HBV)-related cirrhosis in China. Splenectomy plus pericardial devascularization (SPD) and transjugular intrahepatic portosystemic shunt (TIPS) are effective treatments for EGVB. However, a comparison of the effectiveness and safety of those methods is lacking.

AIM

To compare the prognosis after SPD vs TIPS for acute EGVB after failure of endoscopic therapy or secondary prophylaxis of variceal rebleeding (VRB) in patients with HBV-related cirrhosis combined with portal hypertension.

METHODS

This retrospective cohort study included 318 patients with HBV-related cirrhosis and EGVB who underwent SPD or TIPS at West China Hospital of Sichuan University during 2009-2013. Propensity score-matched analysis (PSM), the Kaplan-Meier method, and multivariate Cox regression analysis were used to compare overall survival, VRB rate, liver function abnormality rate, and hepatocellular carcinoma (HCC) incidence between the two patient groups.

RESULTS

The median age was 45.0 years (n = 318; 226 (71.1%) males). During a median follow-up duration of 43.0 mo, 18 (11.1%) and 33 (21.2%) patients died in the SPD and TIPS groups, respectively. After PSM, SPD was significantly associated with better overall survival (OS) (P = 0.01), lower rates of abnormal liver function (P < 0.001), and a lower incidence of HCC (P = 0.02) than TIPS. The VRB rate did not differ significantly between the two groups (P = 0.09).

CONCLUSION

Compared with TIPS, SPD is associated with higher postoperative OS rates, lower rates of abnormal liver function and HCC, and better quality of survival as acute EGVB treatment after failed endoscopic therapy or as secondary prophylaxis of VRB in patients with HBV-related cirrhosis combined with portal hypertension. There is no significant between-group difference in VRB rates.

Keywords: Portal hypertension, Liver cirrhosis, Esophagogastric variceal bleeding, Splenectomy, Pericardial devascularization, Transjugular intrahepatic portosystemic shunt

Core Tip: The choice between splenectomy plus pericardial devascularization (SPD) and transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of esophagogastric variceal bleeding (EGVB) in cirrhosis with portal hypertension is controversial, and few studies have compared the advantages and disadvantages of the two treatments. We compared the efficacy of the two treatments for acute EGVB that failed endoscopic treatment or secondary prevention of variceal rebleeding (VRB). We found no difference in the VRB rate between the two treatments, but the SPD group had a higher overall survival rate and a lower incidence of abnormal liver function and hepatocellular carcinoma than the TIPS group.