Clinical Significance of Splenic Vessels and Anatomical Features in Laparoscopic Splenectomy

Fujinaga, Atsuro; Ohta, Masayuki; Endo, Yuichi; Tada, Kazuhiro; Kawamura, Masahiro; Nakanuma, Hiroaki; Ogawa, Katsuhiro; Watanabe, Kiminori; Kawasaki, Takahide; Masuda, Takashi; Hirashita, Teijiro; Toujigamori, Manabu; Ito, Masafumi

doi:10.1089/lap.2020.0576

Cited by 6 publications

(4 citation statements)

References 23 publications

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“…Studies have shown that in cirrhotic patients with portal hypertension, the wider the portal and splenic veins are, the more likely it is to cause the venous vessel wall to be damaged by the extended high pressure in the lumen [ 30 ]. At the same time, the blood flow rate is slow, promoting coagulation, and when substance removal is slow, it promotes the formation of PVT [ 31 ]. This is consistent with the results of the present study.…”

Section: Discussionmentioning

confidence: 99%

Nomogram Model for Prediction of Portal Vein Thrombosis in Patients with Liver Cirrhosis After Splenectomy: A Retrospective Analysis of 2 Independent Cohorts

et al. 2021

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Background The aim of this study was to establish and validate an easy-to-use nomogram to predict portal vein thrombosis (PVT) in patients with cirrhosis after splenectomy and to test its predictive ability. Material/Methods This retrospective study included 315 patients with cirrhosis who underwent splenectomy at 2 high-volume medical centers. The least absolute shrinkage and selection operator (LASSO) regression method was used to select the predictors in the training cohort, and multivariable logistic regression analysis was performed to establish the predictive nomogram model. We determined the prediction value of the nomogram by the area under the receiver operating characteristic curve (AUROC), the calibration curve, and decision curve analysis. Finally, the applicability of the nomogram was internally and independently validated. Results The predictors of PVT included portal vein diameter, splenic vein diameter, body mass index, and platelet count. Based on the clinical and radiomic models, the nomogram had good predictive efficiency for predicting PVT in patients with cirrhosis after splenectomy, with an AUROC of 0.887 (0.856 in internal validation and 0.796 in independent validation). The decision curve analysis revealed that the nomogram had good clinical application value. Conclusions We successfully developed an easy-to-use nomogram to predict the probability of PVT in patients with cirrhosis after splenectomy. The nomogram can help clinicians make timely, individualized clinical decisions for PVT in patients with cirrhosis after splenectomy.

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Section: Discussionmentioning

confidence: 99%

Nomogram Model for Prediction of Portal Vein Thrombosis in Patients with Liver Cirrhosis After Splenectomy: A Retrospective Analysis of 2 Independent Cohorts

et al. 2021

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“…However, the true impact of surgical approach on the incidence of the pancreatic fistula is unclear [12]. Due to the close contact of the splenic hilum with the pancreatic tail, intraoperative trauma of the pancreas during dissection of the splenic hilum may cause POPF [19]. In a meta-analysis that evaluated the clinical efficacy of surgical technique (laparoscopic or open) in the treatment of ITP, it was not found a significant difference in the incidence of pancreatic fistula between laparoscopic and open splenectomy [17].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Patients with Postoperative Pancreatic Fistula After Isolated Splenectomy: A Retrospective Study

Celik,

Demir,

Gulap

et al. 2024

Eur J Ther

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Objective: Postoperative pancreatic fistula (POPF) is a potentially life-threatening complication. This complication occurs not only after pancreatic surgery but may also arise after other abdominal procedures. In this study, we aimed to determine the incidence and risk factors of POPF in patients undergoing isolated splenectomy. Methods: Patients who underwent isolated splenectomy were identified. POPF was defined according to the 2016 update of International Study Group of Pancreatic Fistula classification and graded as biochemical leak (BL), grade B fistula, and grade C fistula. Characteristics and perioperative variables were compared between patients who had pancreatic fistula and those who have not. Results: The study cohort consisted of 59 patients with median age 38.9 years, and 50.8% male. The indication was trauma in 18 (30.5%) patients. Twenty (33.9%) patients were operated upon emergently. Thirty-seven (62.7%) splenectomies were performed open. Out of all patients, 14 (23.7%) developed any sort of pancreatic fistula. BL occurred in 11 (18.6%) patients and 3 (5.1%) patients developed a grade B fistula. Comparison of patients with and without BL/POPF demonstrated no significant differences in demographics, surgical indication, operative method, surgical approach, or postoperative outcome. Conclusions: Despite higher incidence of pancreatic leak, the rate of clinically relevant fistula is relatively low. In this study, we did not identify any factors associated with BL/POPF. Thus, further studies are needed on pancreatic fistula after splenectomy.

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“…PVD is considered the best indicator for portal hypertension. The wider the portal vein is, the more likely it is to cause damage to the venous vessel wall due to the extended high pressure in the lumen, and when combined with slow blood flow, the blood easily forms a vortex, promoting coagulation and eventually promoting the formation of PVT [ 26 , 27 ]. Dong et al found that PVD was the strongest independent risk factor for predicting PVT development (OR: 3.96, AUC: 0.88; p < 0.01), with a cutoff of >12.5 mm [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Nomogram for Predicting Portal Vein Thrombosis in Cirrhotic Patients: A Retrospective Cohort Study

Ding

Zhao

Miao

et al. 2023

JPM

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Aim: Portal vein thrombosis (PVT) is a common complication in cirrhotic patients and will aggravate portal hypertension, thus leading to a series of severe complications. The aim of this study was to develop a nomogram based on a simple and effective model to predict PVT in cirrhotic patients. Methods: Clinical data of 656 cirrhotic patients with or without PVT in the First Affiliated Hospital of Soochow University and The Third Affiliated Hospital of Nantong University from January 2017 to March 2022 were retrospectively collected, and all patients were divided into training, internal and external validation cohorts. SPSS and R software were used to identify the independent risk factors and construct a predictive model. We evaluated the predictive value of the model by receiver operating characteristic (ROC) curve, calibration curve, and decision curve analyses. The feasibility of the model was further validated in the internal and external cohorts. All enrolled patients were followed up to construct the survival curves and calculate the incidence of complications. Results: The predictors of PVT included serum albumin, D-dimer, portal vein diameter, splenectomy, and esophageal and gastric varices. Based on the clinical and imaging findings, the final model served as a potential tool for predicting PVT in cirrhotic patients, with an AUC of 0.806 (0.766 in the internal validation cohort and 0.845 in the external validation cohort). The decision curve analysis revealed that the model had a high level of concordance between different medical centers. There was a significant difference between the PVT and non-PVT groups in survival analyses, with p values of 0.0477 and 0.0319 in the training and internal validation groups, respectively, along with p value of 0.0002 in the external validation group according to log-rank test; meanwhile, the median survival times of the PVT group were 54, 43, and 40 months, respectively. The incidence of recurrent esophageal and gastric variceal bleeding (EGVB) during the follow-up showed significant differences among the three cohorts (p = 0.009, 0.048, and 0.001 in the training, internal validation, and external validation cohorts, respectively). Conclusion: The nomogram based on our model provides a simple and convenient method for predicting PVT in cirrhotic patients. Cirrhotic patients with PVT had a shorter survival time and were prone to recurrent EGVB compared with those in the non-PVT group.

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Clinical Significance of Splenic Vessels and Anatomical Features in Laparoscopic Splenectomy

Cited by 6 publications

References 23 publications

Nomogram Model for Prediction of Portal Vein Thrombosis in Patients with Liver Cirrhosis After Splenectomy: A Retrospective Analysis of 2 Independent Cohorts

Nomogram Model for Prediction of Portal Vein Thrombosis in Patients with Liver Cirrhosis After Splenectomy: A Retrospective Analysis of 2 Independent Cohorts

Evaluation of Patients with Postoperative Pancreatic Fistula After Isolated Splenectomy: A Retrospective Study

Nomogram for Predicting Portal Vein Thrombosis in Cirrhotic Patients: A Retrospective Cohort Study

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