Laparoscopic Splenectomy with Technical Standardization and Selection Criteria for Standard or Hand-Assisted Approach in 390 Patients with Liver Cirrhosis and Portal Hypertension

Kawanaka, Hirofumi; Akahoshi, Tomohiko; Kinjo, Nao; Harimoto, Norifumi; Itoh, Shinji; Tsutsumi, Norifumi; Matsumoto, Yoshihiro; Yoshizumi, Tomoharu; Shirabe, Ken; Maehara, Yoshihiko

doi:10.1016/j.jamcollsurg.2015.04.011

Cited by 30 publications

(20 citation statements)

References 40 publications

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“…Certainly, when its clinical significance is explained, the regions should be also taken into account. Splenectomy with porta-azygous devascularization is a major treatment option for portal hypertension and hypersplenism in China and Japan [ 7 , 10 , 11 , 16 , 37 ]. By comparison, it is rarely recommended by the practice guidelines and consensus from Western countries [ 38 – 40 ].…”

Section: Discussionmentioning

confidence: 99%

Splenectomy Causes 10-Fold Increased Risk of Portal Venous System Thrombosis in Liver Cirrhosis Patients

Han

Yuan

et al. 2016

Med Sci Monit

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BackgroundPortal venous system thrombosis (PVST) is a life-threatening complication of liver cirrhosis. We conducted a retrospective study to comprehensively analyze the prevalence and risk factors of PVST in liver cirrhosis.Material/MethodsAll cirrhotic patients without malignancy admitted between June 2012 and December 2013 were eligible if they underwent contrast-enhanced CT or MRI scans. Independent predictors of PVST in liver cirrhosis were calculated in multivariate analyses. Subgroup analyses were performed according to the severity of PVST (any PVST, main portal vein [MPV] thrombosis >50%, and clinically significant PVST) and splenectomy. Odds ratios (ORs) and 95% confidence intervals (CIs) were reported.ResultsOverall, 113 cirrhotic patients were enrolled. The prevalence of PVST was 16.8% (19/113). Splenectomy (any PVST: OR=11.494, 95%CI=2.152–61.395; MPV thrombosis >50%: OR=29.987, 95%CI=3.247–276.949; clinically significant PVST: OR=40.415, 95%CI=3.895–419.295) and higher hemoglobin (any PVST: OR=0.974, 95%CI=0.953–0.996; MPV thrombosis >50%: OR=0.936, 95%CI=0.895–0.980; clinically significant PVST: OR=0.935, 95%CI=0.891–0.982) were the independent predictors of PVST. The prevalence of PVST was 13.3% (14/105) after excluding splenectomy. Higher hemoglobin was the only independent predictor of MPV thrombosis >50% (OR=0.952, 95%CI=0.909–0.997). No independent predictors of any PVST or clinically significant PVST were identified in multivariate analyses. Additionally, PVST patients who underwent splenectomy had a significantly higher proportion of clinically significant PVST but lower MELD score than those who did not undergo splenectomy. In all analyses, the in-hospital mortality was not significantly different between cirrhotic patient with and without PVST.ConclusionsSplenectomy may increase by at least 10-fold the risk of PVST in liver cirrhosis independent of severity of liver dysfunction.

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Section: Discussionmentioning

confidence: 99%

Splenectomy Causes 10-Fold Increased Risk of Portal Venous System Thrombosis in Liver Cirrhosis Patients

Han

Yuan

et al. 2016

Med Sci Monit

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“…Dev is performed for patients with BRTO-resistant varices associated with enlarged inflow routes, high-grade portal hypertension, and difficulties in coagulation. However, the surgical procedure has become easy and safe to perform with the recent introduction of a vessel-sealing system and auto-suture devices [23,[35][36][37]. Together with a trend toward less invasive treatment for portal hypertension, the Sp ?…”

Section: Discussionmentioning

confidence: 99%

Treatment outcomes after splenectomy with gastric devascularization or balloon-occluded retrograde transvenous obliteration for gastric varices: a propensity score-weighted analysis from a single institution

et al. 2020

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Background Although balloon-occluded retrograde transvenous obliteration (BRTO) is often selected to treat gastric varices caused by portal hypertension, data comparing BRTO and splenectomy with gastric devascularization (Sp ? Dev) are limited. Methods From January 2009 to February 2018, 100 patients with gastric varices caused by portal hypertension who underwent Sp ? Dev (n = 45) or BRTO (n = 55) were included. Overall survival (OS) and the rebleeding rate were calculated using the inverse probability of a treatment weighting-adjusted log-rank test. Independent risk factors were identified by Cox regression analysis. Changes in liver function and adverse events after the procedures were analyzed. Results Patients in the Sp ? Dev group tended to have lower platelet counts than those in the BRTO group, but liver function did not differ between these groups. The 5-year OS rates for the Sp ? Dev and BRTO groups were 73.4 and 50.0% (p = 0.005), respectively. There were no significant differences in rebleeding rates between the two groups. Multivariate analysis showed that serum albumin level B3.6 g/dL, prothrombin time% activity (PT%) B80%, and serum creatinine level C0.84 mg/dL were poor prognostic factors. Although the Sp ? Dev group had more short-term complications after procedures, Sp ? Dev tended to be more effective in improving liver function than BRTO. Conclusions Sp ? Dev showed better OS and improvement of liver function compared with BRTO for the treatment of gastric varices caused by portal hypertension.

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“…As discussed above, several immune factors contribute to or regulate liver regeneration. Splenectomy has been shown to be beneficial in clinical settings of liver cirrhosis and portal hypertension or hypersplenism . These beneficial effects have been attributed to reduction of the portal circulation .…”

Section: Discussionmentioning

confidence: 99%

“…Splenectomy has been shown to be beneficial in clinical settings of liver cirrhosis and portal hypertension or hypersplenism. (31,32) These beneficial effects have been attributed to reduction of the portal circulation. (33) Furthermore, experiments using rats have shown that splenectomy can result in reduced concentrations of TGFβ and consequently reduced inhibitory effects on liver regeneration.…”

Section: Discussionmentioning

confidence: 99%

B Cell‐Mediated Maintenance of Cluster of Differentiation 169–Positive Cells Is Critical for Liver Regeneration

Behnke¹,

Zhuang²,

Xu³

et al. 2018

Hepatology

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The liver has an extraordinary capacity to regenerate through activation of key molecular pathways. However, central regulators controlling liver regeneration remain insufficiently studied. Here, we show that B cell-deficient animals failed to induce sufficient liver regeneration after partial hepatectomy (PHx). Consistently, adoptive transfer of B cells could rescue defective liver regeneration. B cell-mediated lymphotoxin beta production promoted recovery from PHx. Absence of B cells coincided with loss of splenic cluster of differentiation 169-positive (CD169 ) macrophages. Moreover, depletion of CD169 cells resulted in defective liver regeneration and decreased survival, which was associated with reduced hepatocyte proliferation. Mechanistically, CD169 cells contributed to liver regeneration by inducing hepatic interleukin-6 (IL-6) production and signal transducer and activator of transcription 3 activation. Accordingly, treatment of CD169 cell-depleted animals with IL-6/IL-6 receptor rescued liver regeneration and severe pathology following PHx. Conclusion: We identified CD169 cells to be a central trigger for liver regeneration, by inducing key signaling pathways important for liver regeneration.

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Laparoscopic Splenectomy with Technical Standardization and Selection Criteria for Standard or Hand-Assisted Approach in 390 Patients with Liver Cirrhosis and Portal Hypertension

Cited by 30 publications

References 40 publications

Splenectomy Causes 10-Fold Increased Risk of Portal Venous System Thrombosis in Liver Cirrhosis Patients

Splenectomy Causes 10-Fold Increased Risk of Portal Venous System Thrombosis in Liver Cirrhosis Patients

Treatment outcomes after splenectomy with gastric devascularization or balloon-occluded retrograde transvenous obliteration for gastric varices: a propensity score-weighted analysis from a single institution

B Cell‐Mediated Maintenance of Cluster of Differentiation 169–Positive Cells Is Critical for Liver Regeneration

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