Results of the Selective and Partial Portacaval Bypass and Prognostic Factors of Long-term Survival in Patients with Liver Cirrhosis

Abstract

Aim. To identify the factors of long-term survival in patients with liver cirrhosis after selective and partial portocaval shunts. Materials and Methods. Different types of portocaval shunts were performed in 221 patients including distal splenorenal anastomosis in 131 (59.3%) cases, partial anastomoses in 83 (37.6%) patients, TIPS in 7 patients. Child-Pugh class A was detected in 28.9%, class B – in 56.1%, class C – in 14.9%. Results. Postoperative esophageal bleeding occurred in 13 (8.3%) patients. Thrombosis of mesentericocaval H-anastomosis was diagnosed in 6 cases. There were no thromboses of other portacaval anastomoses during the observation period of more than 10 years. Postoperative mortality was 4.1% among patients with Child-Pughclass C. Life expectancy was determined by the degree of hepatic dysfunction. 1-year survival in patients class A was 98.7 ± 1.3%, 3-year – 87.1 ± 3.2%, 5-year – 66 ± 6.8%, 10-year – 34.1 ± 6.7 %, median is 87 months. Survival rates in Child–Pugh class B were lower: 1-year – 86.5 ± 3.5%, 3-year – 67.4 ± 3.7%, 5-year – 46.6 ± 4.4%, 10-year – 23.2 ± 5.6%, median – 64 months (p = 0.01). Patients of class C had the worst performance (p = 0.001). The Child–Pugh scale was characterized by low predictive accuracy (c-statistic = 0.70). Main predictors of long-term survival were absence of ascites, the portal blood flow > 600 ml / min (c-statistic = 0.81), liver’s volume> 1200 cm3 (c-statistic = 0.80), plasma elimination rate of indocian green > 8% / min (c-statistic = 0.82). Conclusion. Selective and partial portocaval shunts provide sufficient decompression of the portal system and reliable prevention of esophageal-gastric bleedings. Surgical decompression of portal system based on predictors of survival improves the results of surgical treatment of patients with liver cirrhosis