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
To analyse the postoperative survival of patients with portal hypertension and determine the factors that influence survival and construct nomograms.
We retrospectively followed 1045 patients who underwent splenectomy plus pericardial devascularisation (SPD) between January 2002 and December 2017. Two SPD types are used in our department: splenectomy plus simplified pericardial devascularisation (SSPD) and splenectomy plus traditional pericardial devascularisation (STPD). The Kaplan-Meier method and Cox regression analysis were used to evaluate the prognostic effects of multiple parameters on overall survival (OS), disease-specific survival (DSS) and bleeding-free survival (BFS). Significant prognostic factors were combined to build nomograms to predict the survival rate of individual patients.
Five hundred and fifty-seven (53.30%) patients were successfully followed with 192 in the SSPD group and 365 in the STPD group; 93 (16.70%) patients died, of whom 42 (7.54%) died due to bleeding. Postoperative bleeding was observed in 84 (15.10%) patients. The 5- and 10-year OS, DSS and BFS rates in the group of patients who underwent SSPD were not significantly different from those in patients who underwent STPD. Independent prognostic factors for OS were age, operative time, alanine transaminase level and albumin-bilirubin score. Independent prognostic factors for BFS were male sex, age, intraoperative blood loss and time to first flatus. Independent prognostic factors for DSS were the Comprehensive Complication Index and age. These characteristics were used to establish nomograms, which showed good accuracy in predicting 1-, 3- and 5-year OS and BFS.
SSPD achieves or surpasses the long-term survival effect of traditional pericardial devascularisation and is worthy of clinical promotion and application. Nomograms are effective at predicting prognosis.
Core tip: The mortality and re-bleeding rate are still extremely high among patients with portal hypertension after splenectomy plus pericardial devascularisation. This study aimed to analyse the postoperative survival, identify risk factors, construct nomograms, and explore the clinical effect of splenectomy plus simplified pericardial devascularisation (SSPD). Five hundred and fifty-seven (53.30%) patients were successfully followed, and the results suggested that the 5- and 10-year overall survival, disease-specific survival and bleeding-free survival rates were not significantly different between patients who underwent SSPD and patients who underwent splenectomy plus traditional pericardial devascularisation. Age, operative time, alanine transaminase level and albumin-bilirubin score were independent prognostic factors influencing overall survival. Male sex, age, intraoperative blood loss and time to first flatus were independent prognostic factors influencing bleeding-free survival. Comprehensive Complication Index and age were independent prognostic factors influencing disease-specific survival.