Effects of Splenectomy Combined with Pericardial Devascularization (SPD) on Adipopenia in Cirrhotic Portal Hypertension Patients

Background : Splenectomy with periesophagogastric devascularization is one of the most frequently performed surgical procedures by domestic surgical teams in China to reduce the risk of initial and recurrent bleeding from esophagogastric varices. Although the efficacy of this procedure in alleviating hypersplenism and reducing the risk of bleeding and rebleeding has been extensively validated, its potential benefits in ameliorating hypolipidemia and lipodystrophy among cirrhotic patients have rarely been studied. Methods : A retrospective study analyzed 75 cirrhotic portal hypertension patients undergoing splenectomy with devascularization (Jan 2018-Sep 2023) across four Xi'an hospitals. Pre- and postoperative clinical/lab data and abdominal CTs were collected. These were compared with 33 healthy controls. Analyses included: (1) differences between patients and controls; (2) postoperative changes in patients; (3) subgroup effects (age, sex, BMI, SATI); (4) rebleeding rates in preoperative lipodystrophy vs non-lipodystrophy patients; and (5) correlations between changes in key parameters and clinical indicators. Results : Compared to healthy individuals, patients with liver cirrhosis exhibited significantly lower levels of hematopoietic cells (RBC, WBC, PLT), liver function markers (TP, ALB), lipid profiles (TG, TC, HDL, LDL), and adipose indices (VATI, SATI), alongside significantly elevated levels of TBIL, DBIL, PT, and ALBI scores (all P < 0.01). Following splenectomy with devascularization for portal hypertension, patients showed significant increases in RBC, WBC, PLT, HB, TC, HDL, LDL, and SATI, while TBIL, DBIL, and ALBI scores significantly decreased (all P < 0.01). TG levels and VATI remained unchanged postoperatively. Postoperative SATI elevation was significant specifically in non-elderly patients, female patients, and those with hypolipidemia (P < 0.05), whereas no significant change was observed in elderly or male patients, or those without hypolipidemia. The postoperative gastrointestinal rebleeding rate did not differ significantly between hypolipidemia and non-hypolipidemia patients. Correlation analysis revealed a negative correlation between the change in SATI (ΔSATI) and preoperative BMI (r = -0.45), with linear regression confirming BMI as a significant negative predictor of ΔSATI. Changes in TG and TC (ΔTG, ΔTC) showed positive correlations with VATI (r = 0.34 and 0.29, respectively), although VATI was not found to be a significant predictor of ΔTG or ΔTC. Conclusion : Preoperatively, patients with cirrhotic portal hypertension undergoing splenectomy with devascularization exhibited significantly reduced trilineage hematopoiesis, impaired liver and coagulation function, decreased serum lipid profiles (TG, TC, HDL, LDL), and lower visceral and subcutaneous adipose tissue indices (VATI/SATI) compared to healthy controls. Postoperative resolution of hypersplenism improved hepatic and coagulation function, elevated serum lipids (TC, HDL, LDL), and significantly increased subcutaneous adipose tissue index (SATI), while visceral adipose tissue index (VATI) remained unaffected. Notably, non-elderly patients, females, individuals with lower preoperative BMI, and those with adipose reduction demonstrated more significant SATI improvement. A significant inverse correlation was observed between the magnitude of SATI change (ΔSATI) and preoperative BMI (r =-0.45), indicating that lower preoperative BMI predicted greater postoperative SATI gain. This suggests distinct benefits of the procedure in ameliorating body composition among patients with suboptimal nutritional status.