Effects of laparoscopic splenectomy and azygoportal disconnection on liver reserve function for cirrhosis patients: a 1-year prospective study.

BACKGROUND: In Asia, laparoscopic splenectomy and azygoportal disconnection (LSD) is a primary and effective treatment for patients with cirrhotic portal hypertension. While LSD is widely recognized to improve liver function in cirrhosis, its specific effect on liver reserve function remains underexplored. This prospective study aimed to evaluate whether LSD enhances liver reserve function in these patients. METHODS: Clinical data were collected over a 1-year follow-up after LSD, including the Child-Pugh score and class, albumin-bilirubin (ALBI) score and grade, indocyanine green retention rate at 15 min (ICG-R15), its plasma clearance rate (ICG-K), and its half-life (ICG-T1/2). RESULTS: After screening, 68 patients were included. At one year postoperatively, both Child-Pugh class and ALBI grade improved significantly after LSD (F = 4.52 and 7.48, respectively; both P < 0.001). Similarly, ICG-R15, ICG-K, and ICG-T1/2 all showed significant improvement compared to preoperative baseline values (F = 9.40, 69.43, 32.47, respectively; all P < 0.001). Moreover, compared to baseline, ICG-R15, ICG-K, and ICG-T1/2 demonstrated progressive and significant improvement from postoperative month (POM) 3 through POM 6 and POM 12 (all P < 0.001). Their maximum improvement was observed at POM 12, with changes of 42.3%, 25.8%, and 29.0%, respectively. These positive trends were consistently observed across their three ICG-R15-based subgroups (10% ≤ ICG-R15 < 20%, 20% ≤ ICG-R15 < 40%, and ICG-R15 ≥ 40%). CONCLUSION: LSD enhances liver reserve function in patients with cirrhotic portal hypertension. This improvement may contribute to a better quality of life and greater tolerance for potential future therapies, such as those required in the event of hepatocellular carcinoma. The trial registration identifier at clinicaltrials.gov is NCT05325437.