Retrospective Cohort Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Feb 27, 2024; 16(2): 318-330
Published online Feb 27, 2024. doi: 10.4240/wjgs.v16.i2.318
Will partial splenic embolization followed by splenectomy increase intraoperative bleeding?
Long Huang, Qing-Lin Li, Qing-Sheng Yu, Hui Peng, Zhou Zhen, Yi Shen, Qi Zhang
Long Huang, Qing-Sheng Yu, Hui Peng, Yi Shen, Qi Zhang, Department of No. 1 Surgery, The First Hospital Affiliated to Anhui University of Traditional Chinese Medicine, Hefei 230031, Anhui Province, China
Qing-Lin Li, Anhui University of Traditional Chinese Medicine, Anhui University of Traditional Chinese Medicine, Hefei 230038, Anhui Province, China
Zhou Zhen, Department of Surgery, The Second Hospital Affiliated to Anhui University of Traditional Chinese Medicine, Hefei 230061, Anhui Province, China
Author contributions: Huang L wrote the paper; Huang L, Li QL and Yu QS designed the research; Shen Y and Zhang Q performed the research; Peng H and Zhen Z analyzed the data; All authors made substantial intellectual contributions to this paper.
Supported by National Natural Science Foundations of China, No. 82174160; and Anhui Natural Science Foundation, No. 2008085QH389.
Institutional review board statement: The study was reviewed and approved by the Anhui Provincial Traditional Chinese Hospital.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrollment.
Conflict-of-interest statement: All the Authors have no conflict of interest related to the manuscript.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at huanglong658@163.com.
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: Long Huang, MD, Chief Doctor, Doctor, Professor, Department of No. 1 Surgery, The First Hospital Affiliated to Anhui University of Traditional Chinese Medicine, No. 117 Meishan Road, Hefei 230031, Anhui Province, China. huanglong658@163.com
Received: October 2, 2023
Peer-review started: October 2, 2023
First decision: December 6, 2023
Revised: December 17, 2023
Accepted: January 25, 2024
Article in press: January 25, 2024
Published online: February 27, 2024
Processing time: 146 Days and 2.5 Hours
Abstract
BACKGROUND

Partial splenic embolization (PSE) has been suggested as an alternative to splenectomy in the treatment of hypersplenism. However, some patients may experience recurrence of hypersplenism after PSE and require splenectomy. Currently, there is a lack of evidence-based medical support regarding whether preoperative PSE followed by splenectomy can reduce the incidence of complications.

AIM

To investigate the safety and therapeutic efficacy of preoperative PSE followed by splenectomy in patients with cirrhosis and hypersplenism.

METHODS

Between January 2010 and December 2021, 321 consecutive patients with cirrhosis and hypersplenism underwent splenectomy at our department. Based on whether PSE was performed prior to splenectomy, the patients were divided into two groups: PSE group (n = 40) and non-PSE group (n = 281). Patient characteristics, postoperative complications, and follow-up data were compared between groups. Propensity score matching (PSM) was conducted, and univariable and multivariable analyses were used to establish a nomogram predictive model for intraoperative bleeding (IB). The receiver operating characteristic curve, Hosmer-Lemeshow goodness-of-fit test, and decision curve analysis (DCA) were employed to evaluate the differentiation, calibration, and clinical performance of the model.

RESULTS

After PSM, the non-PSE group showed significant reductions in hospital stay, intraoperative blood loss, and operation time (all P = 0.00). Multivariate analysis revealed that spleen length, portal vein diameter, splenic vein diameter, and history of PSE were independent predictive factors for IB. A nomogram predictive model of IB was constructed, and DCA demonstrated the clinical utility of this model. Both groups exhibited similar results in terms of overall survival during the follow-up period.

CONCLUSION

Preoperative PSE followed by splenectomy may increase the incidence of IB and a nomogram-based prediction model can predict the occurrence of IB.

Keywords: Partial splenic embolization; Splenectomy; Hypertension, Portal; Liver Cirrhosis; Intraoperative bleeding

Core Tip: Partial splenic embolization (PSE) has been suggested as an alternative to splenectomy for treating hypersplenism, but some patients may experience recurrence of hypersplenism after PSE and still require splenectomy. Preoperative PSE followed by splenectomy may increase the incidence of intraoperative bleeding (IB), and a nomogram-based prediction model can predict the occurrence of IB.