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The decreased risk of hepatocellular carcinoma in hepatitis B virus-related cirrhotic portal hypertension patients after laparoscopic splenectomy and azygoportal disconnection.
- Source :
-
Surgical endoscopy [Surg Endosc] 2023 Nov; Vol. 37 (11), pp. 8522-8531. Date of Electronic Publication: 2023 Sep 29. - Publication Year :
- 2023
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Abstract
- Background: Posthepatitic cirrhosis is one of the leading risk factors for hepatocellular carcinoma (HCC) worldwide, among which hepatitis B cirrhosis is the dominant one. This study explored whether laparoscopic splenectomy and azygoportal disconnection (LSD) can reduce the risk of HCC among patients with hepatitis B virus (HBV)-related cirrhotic portal hypertension (CPH).<br />Methods: A total of 383 patients with HBV-related CPH diagnosed as gastroesophageal variceal bleeding and secondary hypersplenism were identified in our hepatobiliary pancreatic center between April 2012 and April 2022, and conducted an 11-year retrospective follow-up. We used inverse probability of treatment weighting (IPTW) to correct for potential confounders, weighted Kaplan-Meier curves, and logistic regression to estimate survival and risk differences.<br />Results: Patients were divided into two groups based on treatment method: LSD (n = 230) and endoscopic therapy (ET; n = 153) groups. Whether it was processed through IPTW or not, LSD group showed a higher survival benefit than ET group according to Kaplan-Meier analysis (P < 0.001). The incidence density of HCC was higher in the ET group compared to LSD group at the end of follow-up [32.1/1000 vs 8.0/1000 person-years; Rate ratio: 3.998, 95% confidence intervals (CI) 1.928-8.293]. Additionally, in logistic regression analyses weighted by IPTW, LSD was an independent protective predictor of HCC incidence compared to ET (odds ratio 0.516, 95% CI 0.343-0.776; P = 0.002).<br />Conclusion: Considering the ability of LSD to improve postoperative survival and prevent HCC in HBV-related CPH patients with gastroesophageal variceal bleeding and secondary hypersplenism, it is worth promoting in the context of the shortage of liver donors.<br /> (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
- Subjects :
- Humans
Hepatitis B virus
Retrospective Studies
Splenectomy adverse effects
Gastrointestinal Hemorrhage etiology
Liver Cirrhosis complications
Liver Cirrhosis surgery
Carcinoma, Hepatocellular surgery
Carcinoma, Hepatocellular complications
Esophageal and Gastric Varices surgery
Esophageal and Gastric Varices complications
Hypersplenism surgery
Hypersplenism complications
Liver Neoplasms surgery
Liver Neoplasms complications
Laparoscopy adverse effects
Hypertension, Portal surgery
Hypertension, Portal complications
Subjects
Details
- Language :
- English
- ISSN :
- 1432-2218
- Volume :
- 37
- Issue :
- 11
- Database :
- MEDLINE
- Journal :
- Surgical endoscopy
- Publication Type :
- Academic Journal
- Accession number :
- 37775601
- Full Text :
- https://doi.org/10.1007/s00464-023-10454-7