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
ARTICLE HIGHLIGHTS
Research background

The primary goals of the portal hypertension management program are prevention of first esophagogastric variceal bleeding (EGVB), control of acute EGVB, and prevention of variceal rebleeding (VRB). Splenectomy combined with pericardial devascularization (SPD) and transjugular intrahepatic portosystemic shunt (TIPS) are suggested in China as salvage therapies for patients with acute EGVB who have failed endoscopic treatment or as secondary prophylaxis of VRB. However, it is unclear whether SPD or TIPS is more effective and safe in the treatment of acute EGVB and as secondary prevention of VRB.

Research motivation

Both SPD and TIPS are effective treatments for EGVB, but the effectiveness and safety of both methods are currently controversial.

Research objectives

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

Research methods

This was a retrospective study. We used propensity score matching analysis (PSM), Kaplan-Meier method, and multivariate Cox regression analysis to compare the effectiveness and safety of the two treatment modalities for comparative analysis.

Research results

We found that SPD was significantly associated with better overall survival (OS) (P = 0.01), lower rates of liver function abnormalities (P < 0.001), and a lower incidence of HCC (P = 0.02) than TIPS. There was no significant difference in VRB rates between the two groups (P = 0.09).

Research conclusions

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.

Research perspectives

This study may provide a clinical basis for the treatment of patients with portal hypertension combined with EGVB.