Splenectomy versus non-splenectomy for gastrointestinal bleeding from left-sided portal hypertension: a systematic review and meta-analysis
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PROVIDER: S-EPMC10916482 | biostudies-literature | 2024 Jan
REPOSITORIES: biostudies-literature
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Project description:Pulmonary hypertension (PH) is the end result of a variety of diverse pathologic processes. The chronic elevation in pulmonary artery pressure often leads to right ventricular pressure overload and subsequent right ventricular failure. In patients with left-sided cardiac disease, PH is quite common and associated with increased morbidity and mortality. This article will review the literature as it pertains to the epidemiology, pathogenesis, and diagnosis of PH related to aortic valve disease, mitral valve disease, left ventricular systolic and diastolic dysfunction, and pulmonary veno-occlusive disease. Moreover, therapeutic strategies, which focus on treating the underlying cardiac pathology will be discussed.
| S-EPMC3109401 | biostudies-other
Project description:IntroductionLaparoscopic colectomy has been widely used clinically due to its minimally invasive advantages, and many studies have also demonstrated its safety and efficacy. However, the efficacy of laparoscopic left hemicolectomy remains unclear due to the differences in pathogenesis and surgical details between left and right colon cancers. Therefore, we plan to conduct a systematic review and meta-analysis to investigate whether laparoscopic techniques can be safely used in left hemicolectomy.Method and analysisThis meta-analysis protocol will be completed and reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols guidelines. A systematic search was performed for all articles related to laparoscopic left hemicolectomy in PubMed, Web of Science, Medline, EMBASE and the Cochrane Library from inception to 5 November 2021. Article screening and data extraction were performed independently by two authors and cross-checked after completion. The literature to be included will use corresponding tools for bias risk assessment. Subgroup analyses and sensitivity analyses will be used to explore potential heterogeneity.Ethics and disseminationBecause this systematic review is based on studies with published results and does not involve intervention in patients, no ethical review is required. The results of this study will be published in a peer-reviewed journal.Prospero registration numberCRD42022291526.
| S-EPMC9226930 | biostudies-literature
Project description:Portal venous system thrombosis (PVST) is a life-threatening complication of splenectomy. A meta-analysis was conducted to explore the role of pharmacologic prophylaxis of PVST after splenectomy. Overall, 359 papers were initially identified via the PubMed, EMBASE, and Cochrane Library databases. Eight of them were eligible. The incidence of PVST after splenectomy was significantly lower in patients who received the preventive measures than in those who did not (odds ratio [OR]: 0.33, 95% confidence interval [CI]: 0.22-0.47, P < 0.00001). Subgroup analyses demonstrated that the significant difference remained in studies including patients with portal hypertension (n = 6), but not in those including patients with hematological diseases (n = 2); the significant difference remained in studies using any type of prophylactic drugs (anticoagulants [n = 6], thrombolytics [n = 1], and prostaglandin E1 [n = 1]); the significant difference remained in nonrandomized studies (n = 5), but not in randomized studies (n = 3). The risk of bleeding was similar between the two groups (OR: 0.65, 95% CI: 0.10-4.04, P = 0.64). In conclusion, pharmacologic prophylaxis might decrease the incidence of PVST after splenectomy in patients with portal hypertension and did not increase the risk of bleeding. However, the effect of pharmacologic prophylaxis of PVST in patients with hematological diseases remained questioned.
| S-EPMC4163290 | biostudies-literature
Project description:This study aimed to explore the association of tumor sidedness with the prognosis of patients with colon signet ring cell carcinoma (SRCC). Eligible patients were retrieved from the Surveillance, Epidemiology, and End Results database between 2004 and 2015. Cancer-specific survival (CSS) and overall survival (OS) were compared between patients with left-sided colon SRCC and those with right-sided lesions. A total of 2660 patients were included, among them, 1983 (74.5%) had right-sided colon SRCC. Compared to patients with left-sided colon SRCC, those who had the right-sided colon SRCC showed higher proportion of white race, female, aged ??65 years, receiving total colectomy and ??4 regional lymph node dissection; while had lower proportion of advanced AJCC stage. Besides, right-sided patients exhibited superior 5-year CSS (32.74% vs. 25.89%, P?=?0.001) and OS (27.38% vs. 23.02%, P?=?0.024) rates compared with left-sided ones. Multivariate analysis revealed that tumor sidedness was an independent prognostic factor. To be specific, patients with right-sided colon SRCC showed better CSS (HR: 0.873; 95% CI 0.777-0.981; P?=?0.023) and OS (HR: 0.838; 95% CI 0.753-0.965; P?=?0.002). Moreover, subgroup analysis demonstrated superior CSS and OS for right-sided patients in most subgroups. Tumor sidedness was an independent prognostic indicator for colon SRCC. Besides, patients with right-sided colon SRCC have superior prognosis than those with left-sided lesions.
| S-EPMC7578060 | biostudies-literature
Project description:Despite the importance of Helicobacter pylori infection and portal hypertension (PH)-associated gastrointestinal (GI) diseases, such as esophageal varices and portal hypertensive gastropathy (PHG), the impact of H. pylori infection on PH-related GI complications has not yet been elucidated. This meta-analysis investigated the association between H. pylori infection and the risk of PH-related GI complications. An electronic search for original articles published before May 2020 was performed using PubMed, EMBASE, and the Cochrane Library. Independent reviewers conducted the article screening and data extraction. We used the generic inverse variance method for the meta-analysis, and Begg's rank correlation test and Egger's regression test to assess publication bias. A total of 1,148 cases of H. pylori infection and 1,231 uninfected controls were included from 13 studies. H. pylori infection had no significant association with esophageal varices [relative risk (RR) = 0.96, 95% confidence interval (CI) = 0.87-1.06 for all selected studies; RR = 0.95, 95% CI = 0.84-1.07 for cohort studies; odds ratio (OR) = 0.96, 95% CI = 0.60-1.54 for case-control studies]. Although H. pylori infection was significantly associated with PHG in case-control studies [OR = 1.86, 95% CI = 1.17-2.96], no significant differences were found in the cohort studies [RR = 0.98, 95% CI = 0.91-1.05] or all studies combined [RR = 1.18, 95% CI = 0.93-1.52]. In conclusion, H. pylori infection was not associated with the risk of PH-related GI complications. Clinicians should carefully treat cirrhotic patients with PH-related GI complications, regardless of H. pylori infection.
| S-EPMC8782498 | biostudies-literature
Project description:BackgroundSinusoidal obstruction syndrome has been reported after oxaliplatin-based chemotherapy, but liver fibrosis and non-cirrhotic portal hypertension (NCPH) are rarely reported.Case summaryHere, we describe the case of a 64-year-old woman who developed isolated gastric variceal bleeding 16 mo after completing eight cycles of oxaliplatin combined with capecitabine chemotherapy after colon cancer resection. Surprisingly, splenomegaly and thrombocytopenia were not accompanied by variceal bleeding, which has been reported to have predictive value for gastric variceal formation. However, a liver biopsy showed fibrosis in the portal area, suggesting NCPH. The patient underwent endoscopic treatment and experienced no further symptoms.ConclusionIt is necessary to guard against long-term complications after oxaliplatin-based chemotherapy. Sometimes splenic size and platelet level may not always accurately predict the occurrence of portal hypertension.
| S-EPMC9346464 | biostudies-literature
Project description:Background: The survival benefits of radical treatment (resection or radiofrequency ablation) combined with splenectomy for primary hepatocellular carcinoma (HCC) in patients with liver-cirrhosis-associated portal hypertension (PH) remain to be clarified. Methods: 96 patients undertaking HCC radical treatment combined with splenectomy (HS group) were retrospectively analyzed, 48 of whom belonged to HCC stage T1 (HSS group). Another 42 patients at stage T1 with PH who received hepatectomy (or radiofrequency ablation) alone (HA group) during the same period served as the control group. Recurrence-free survival (RFS) and overall survival (OS) were compared at each time point between the HSS and HA group. The risk factors affecting early RFS and OS were confirmed through COX multivariate analysis. Results: The median RFS was 22.3 months and the mean median OS was 46 months in the HS group. As such, 1-year, 2-year, 3-year, and 5-year RFS rates in the HSS and HA group were 95% and 81% (p = 0.041), 81% and 67% (p = 0.05), 64% and 62% (p = 1.00), and 29% and 45% (p = 0.10), respectively. Further, 1-year, 3-year, and 5-year OS rates in the HSS and HA group were 98% and 98% (p = 1.00), 79% and 88% (p = 0.50), and 60% and 64% (p = 0.61), respectively. Cox multivariate analysis showed that preoperative irregular anti-viral therapy, Child-Pugh grade B liver function, vascular invasion, and microvascular invasion (MVI) were independent risk factors for early postoperative RFS (within 2 years), and preoperative irregular anti-viral therapy and vascular invasion were independent risk factors for 5-year OS. Conclusions: Radical treatment of HCC combined with synchronous splenectomy, especially applicable to patients with Child-Pugh grade A liver function, can significantly improve early postoperative RFS in patients with stage T1 HCC and liver-cirrhosis-associated portal hypertension, but fail to improve OS.
| S-EPMC9264870 | biostudies-literature
Project description:BackgroundLeft-sided portal hypertension (LSPH) caused by splenic vein (SV) division in pancreaticoduodenectomy (PD) with portal vein (PV) resection remains challenging. The current study aimed to investigate the efficacy of splenic artery (SA) ligation in preventing LSPH.MethodsOne-hundred thirty patients who underwent PD with PV resection for pancreatic ductal adenocarcinoma were classified into SV and SA preservation (SVP, n = 30), SV resection and SA preservation (SVR, n = 59), and SV resection and SA ligation (SAL, n = 41). The postoperative incidence of LSPH was assessed.ResultsThe incidence of variceal formation in SVP, SVR, and SAL were 4.8%, 53.2%, and 46.4% at 3 mo, 13.0%, 71.2%, and 62.5% at 6 mo, and 25.0%, 87.5%, and 87.1% at 12 mo, respectively. The rate was significantly higher in SVR at 3 and 6 mo (P = .001 and P < .001, respectively) and in SVR and SAL (P < .001) at 12 mo. Variceal hemorrhage occurred only in SVR (n = 4). The platelet count ratio at 3, 6, and 12 mo began to significantly decrease from 3 mo in SVR (0.77, 0.67, and 0.60, respectively; P < .001) and 6 mo in SAL (0.91, 0.73, and 0.69, respectively; P < .001). The spleen volume ratio also showed significant increase from 3 mo in SVR (1.24, 1.34, and 1.42, respectively; P < .001) and 6 mo in SAL (1.31, 1.32, and 1.34, respectively; P < .001). SVR and SAL were significant risk factors for variceal formation at 12 mo (odds ratio, 21.0 and 20.3, respectively).ConclusionIn PD with PV resection, SAL delayed LSPH but could not prevent its occurrence.
| S-EPMC9130910 | biostudies-literature
Project description:BackgroundWe aimed to explore the benefit of splenectomy combined with curative treatments (liver resection or local ablation) for patients with hepatocellular carcinoma and portal hypertension.MethodsThe records of 239 patients with hepatocellular carcinoma and portal hypertension undergoing either splenectomy combined with liver resection or local ablation were reviewed retrospectively. Perioperative complications and survival outcome were evaluated, and liver function 1 year later was reassessed according to the Child score.ResultsThe post-hepatectomy liver failure rates and 30-day mortality were 3.3% and 2.1%, respectively. The 1-, 3-, and 5-year overall survival rates were 95.1%, 73%, and 47.5% for patients with Child grade A and 92.2%, 51.2%, and 19.8% for Child grade B, respectively. The median survival time for patients with Child scores of 5, 6, 7, 8, and 9 were 61.5, 51.3, 44.8, 33.7, and 23.4 months, respectively. After multivariable analysis, tumor size, tumor number, post-hepatectomy liver failure, and Child score were independent risk factors for overall survival. Liver function was converted to Child grade A in 98 of 101 patients (97%) who had preoperative Child grade B 1 year after splenectomy.ConclusionPatients with hepatocellular carcinoma and portal hypertension can benefit from splenectomy combined with curative treatments, especially those with Child scores of 5, 6, and 7. Liver function improved significantly 1 year after splenectomy in patients with preoperative Child grade B.
| S-EPMC6831533 | biostudies-literature
Project description:Background/purposeRisk factors for re-bleeding and death after acute variceal bleeding (AVB) in cirrhotic HCC patients are not fully understood.We aimed to (1) explore how the combination of high-risk esophageal varices, HCC status, and portal vein tumor thrombus (i.e., HCC Portal Hypertension Imaging Score [HCCPHTIS]) helps predict increased risk of variceal re-bleeding and mortality; (2) assess predictability and reproducibility of the identified variceal re-bleeding rules.MethodsThis prospective study included 195 HCC patients with first-time AVB and liver cirrhosis, and conducted multivariable Cox regression analysis and Kaplan-Meier analysis. Receiver operating characteristic curve analysis was calculated to find the optimal sensitivity, specificity, and cutoff values of the variables. The reproducibility of the results obtained was verified in a different but related group of patients.Results56 patients (28.7%) had re-bleeding within 6 weeks; HCCPHTIS was an independent risk factor for variceal re-bleeding after AVB (Odd ratio, 2.330; 95% confidence interval: 1.728-3.142, p < 0.001). The positive predictive value of HCCPHTIS cut off value > 3 was 66.2%, sensitivity 83.9%, and specificity 82.3%. HCCPHTIS area under the curve was higher than Child-Pugh score (89% vs. 75%, p < 0.001). 74(37.9%) death occurred within 6 weeks; HCCPHTIS > 4 was associated with increased risk of death within 6 weeks after AVB (p < 0.001).ConclusionHCCPHTIS > 3 is a strong predictor of variceal re-bleeding within the first 6 weeks. However, patients with HCCPHTIS > 4 were at increased risk of death within 6 weeks.
| S-EPMC10976815 | biostudies-literature