The decreased risk of hepatocellular carcinoma in hepatitis B virus-related cirrhotic portal hypertension patients after laparoscopic splenectomy and azygoportal disconnection.

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).

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.

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).

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.

• Authors: Tian-Ming Gao, Kun-Qing Xiao, Xiao-Xing Xiang, Sheng-Jie Jin, Jian-Jun Qian, Chi Zhang, Bao-Huan Zhou, Hua Tang, Dou-Sheng Bai, Guo-Qing Jiang
• Journal: Surgical endoscopy (Surg Endosc) Vol. 37 Issue 11 Pg. 8522-8531 (Nov 2023) ISSN: 1432-2218 [Electronic] Germany
• PMID: 37775601 (Publication Type: Journal Article)
• Copyright: © 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

Topics

• Humans
• Carcinoma, Hepatocellular (surgery, complications)
• Hepatitis B virus
• Esophageal and Gastric Varices (surgery, complications)
• Retrospective Studies
• Hypersplenism (surgery, complications)
• Splenectomy (adverse effects)
• Liver Neoplasms (surgery, complications)
• Gastrointestinal Hemorrhage (etiology)
• Laparoscopy (adverse effects)
• Hypertension, Portal (surgery, complications)
• Liver Cirrhosis (complications, surgery)