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Impact of concurrent splenectomy and esophagogastric devascularization on surgical outcomes of partial hepatectomy for hepatocellular carcinoma in patients with clinically significant portal hypertension: A multicenter propensity score matching analysis.

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机构： [1]Department of Hepatobiliary Surgery, The 1st Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China [2]Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Military University, Second Military Medical University, Shanghai, China [3]Department of Hepatobiliary Surgery, The First Affiliated Hospital of Nantong University, Nantong, Jiangsu, China [4]Department of General Surgery, First People's Hospital of Ziyang, Sichuan, China [5]Department of Hepatobiliary Surgery, People's Hospital of Pu'er, Yunnan, China [6]Department of General Surgery, People's Hospital of Liuyang, Hunan, China [7]Department of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China [8]Department of Hepatobiliary Surgery, People's Hospital of Zhejiang Provincial, People's Hospital of Hangzhou Medical College, Zhejiang, China [9]Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China [10]Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China [11]Department of Surgery, Ohio State University, Wexner Medical Center, Columbus, OH, United States [12]School of Clinical Medicine, Hangzhou Medical College, Hangzhou, Zhejiang, China

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Portal hypertension due to cirrhosis is common among patients with hepatocellular carcinoma (HCC). This study aimed to compare the outcomes of partial hepatectomy in patients with HCC and clinically significant portal hypertension (CSPH) with or without concurrent splenectomy and esophagogastric devascularization (CSED).From a multicenter database, patients with HCC and CSPH who underwent curative-intent hepatectomy were identified. Postoperative morbidity and mortality, and long-term overall survival (OS) were compared in patients with and without CSED before and after propensity score matching (PSM).Of the 358 enrolled patients, 86 patients underwent CSED. Before PSM, the postoperative 30-day morbidity and mortality rates were comparable between the CSED and non-CSED group (both P > 0.05). Using PSM, 81 pairs of patients were created. In the PSM cohort, the 5-year OS rate of the CSED group were significantly better than the non-CSED group (52.9% vs. 36.5%, P= 0.046). The former group had a significantly lower rate of variceal bleeding on follow-up (7.4% vs. 21.7%, P= 0.014). On multivariate analysis, CSED was associated with significantly better OS (HR: 0.39, P < 0.001).Hepatectomy and CSED can safely be performed in selected patients with HCC and CSPH, which could improve postoperative prognosis by preventing variceal bleeding, and prolonging long-term survival.Copyright © 2021. Published by Elsevier Ltd.

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出版当年[2021]版：

大类 | 3 区医学

小类 | 2 区外科 3 区肿瘤学

最新[2023]版：

大类 | 2 区医学

小类 | 2 区肿瘤学 2 区外科

第一作者：

第一作者机构： [1]Department of Hepatobiliary Surgery, The 1st Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China

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通讯作者：

通讯机构： [1]Department of Hepatobiliary Surgery, The 1st Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China [2]Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Military University, Second Military Medical University, Shanghai, China [8]Department of Hepatobiliary Surgery, People's Hospital of Zhejiang Provincial, People's Hospital of Hangzhou Medical College, Zhejiang, China [12]School of Clinical Medicine, Hangzhou Medical College, Hangzhou, Zhejiang, China [*1]Department of Hepatobiliary Surgery, The First Affiliated Hospital of Harbin Medical University, No. 23, Youzheng Road, Heilongjiang, 150006, China. [*2]Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Military University, Second Military Medical University, No. 225, Changhai Road, Shanghai 200438, China. [*3]Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Military University, Second Military Medical University, No. 225, Changhai Road, Shanghai 200438, China.

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