Textbook outcomes after splenectomy in patients with portal hypertension

The Textbook Outcome (TO) is a composite outcome measure that integrates commonly utilized independent outcome measures to comprehensively reflect the optimal post-surgical treatment result. It is used to assess the quality of surgeries and has been widely employed in hepatobiliary and pancreatic surgeries. However, its utility in splenic surgery remains unknown. Patients with cirrhosis and portal hypertension are often managed with splenectomy. The objective of this study was to investigate the perioperative textbook outcomes of splenectomy and identify the risk factors associated with achieving textbook outcomes after undergoing splenectomy. The clinical data of 263 patients with portal hypertension and hypersplenism who underwent splenectomy at our hospital were retrospectively analyzed. Perioperative clinical data were statistically analyzed using t-test, Wilcoxon test, χ² test, or Fisher exact test. The 10-year survival and the incidence of postoperative hepatocellular carcinoma (HCC) were assessed using the Kaplan-Meier method and compared using the Log-Rank test. Among the 263 enrolled patients, 139 (52.85%) achieved textbook outcomes. Multivariate analysis revealed that preoperative prothrombin time and splenic vein diameter were independent risk factors for attaining textbook outcomes in patients undergoing splenectomy. The success rate of minimally invasive surgery was comparable to that of open surgery. Patients with high prognostic nutritional index and low Child-Pugh scores exhibited higher success rates. At 10-years of follow-up, there was no significant differences observed in terms of overall survival or hepatocellular carcinoma (HCC) incidence. However, patients who achieved TO demonstrated a higher long-term survival rate and a lower HCC incidence. Textbook outcomes serve as a comprehensive tool for assessing the quality of splenectomy. This study offers valuable insights guiding surgical treatment decisions for splenic diseases.