Abstract
Background
Portal vein system thrombosis (PVST) is a potentially fatal complication after splenectomy with esophagogastric devascularization (SED) in cirrhotic patients with portal hypertension. However, the impact of portal vein velocity (PVV) on PVST after SED remains unclear. Therefore, this study aims to explore this issue.
Methods
Consecutive cirrhotic patients with portal hypertension who underwent SED at Tongji Hospital between January 2010 and June 2022 were enrolled. The patients were divided into two groups based on the presence or absence of PVST, which was assessed using ultrasound or computed tomography after the operation. PVV was measured by duplex Doppler ultrasound within one week before surgery. The independent risk factors for PVST were analyzed using univariate and multivariate logistic regression analysis. A nomogram based on these variables was developed and internally validated using 1000 bootstrap resamples.
Results
A total of 562 cirrhotic patients with portal hypertension who underwent SED were included, and PVST occurred in 185 patients (32.9%). Multivariate logistic regression analysis showed that PVV was the strongest independent risk factor for PVST. The incidence of PVST was significantly higher in patients with PVV ≤ 16.5 cm/s than in those with PVV > 16.5 cm/s (76.2% vs. 8.5%, p < 0.0001). The PVV-based nomogram was internally validated and showed good performance (optimism-corrected c-statistic = 0.907). Decision curve and clinical impact curve analyses indicated that the nomogram provided a high clinical benefit.
Conclusion
A nomogram based on PVV provided an excellent preoperative prediction of PVST after splenectomy with esophagogastric devascularization.
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References
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Acknowledgements
The authors would like to thank all the medical staff involved in this study.
Funding
This work was supported by Hubei Provincial Special Grants for Scientific and Technical Innovation (2021BCA115).
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Study concepts: J-LW, Z-WZ; Study design: J-LW, Z-WZ, E-LZ, Z-YH; Data acquisition: J-LW; Data analysis and interpretation: J-LW, JL, W-QW; Statistical analysis: J-LW, JL, XL, R-HZ, TY; Manuscript editing: J-LW; Manuscript review: E-LZ, Z-WZ, Z-YH. All authors read and approved the final version of the manuscript.
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Jin-lin Wang, Jian Li, Wen-qiang Wang, Xing Lv, Rong-hua Zhu, Tong Yuan, Er-lei Zhang, Zhi-wei Zhang, and Zhi-yong Huang have no conflicts of interest to disclose.
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Wang, Jl., Li, J., Wang, Wq. et al. Portal vein velocity predicts portal vein system thrombosis after splenectomy with esophagogastric devascularization. Surg Endosc 38, 648–658 (2024). https://doi.org/10.1007/s00464-023-10566-0
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DOI: https://doi.org/10.1007/s00464-023-10566-0