Will partial splenic embolization followed by splenectomy increase intraoperative bleeding?

Figure 1 Situation of the spleen with/without partial splenic embolization. A: Splenomegaly without partial splenic embolization (PSE); B: Adhesion between spleen and omentum with preoperative PSE; C: Splenic infarction with preoperative PSE.

Figure 2 Classification and flow diagram of the study population. HS: Hereditary spherocytosis; IB: Intraoperative bleeding; ITP: Idiopathic thrombocytopenic purpura; PSE: Partial splenic embolization; PSM: Propensity score matching.

Figure 3 Nomogram predictive model for the risk of intraoperative bleeding in patients with cirrhosis and hypersplenism. The nomogram gives every predictive variable a score on the point scale. A total score was calculated by summing the points from each variable, marking the estimated probability of intraoperative bleeding occurrence in included patients. ^aP < 0.05. ^bP < 0.01. LS: Length of the spleen; PSE: Partial splenic embolization; PVD: Portal vein diameter; SVD: Splenic vein diameter.

Figure 4 Discrimination of receiver operating characteristic curve curves of the nomogram model. AUC: Area under curve; ROC: Receiver operating characteristic curve.

Figure 5 Nomogram calibration curve to predict the risk of intraoperative bleeding in in patients with cirrhosis and hypersplenism based on Hosmer-Lemeshow goodness-of-fit test. X-axis represents the probability of nomogram prediction of intraoperative bleeding (IB), and Y-axis represents the actual incidence of IB.

Figure 6 Nomogram decision curve analysis for intraoperative bleeding prediction in included patients. The Y-axis represents the net benefit, which was calculated as the true incidence of intraoperative bleeding minus the false-positive rate (true positive rate), the red and blue lines represent the nomogram prediction probability, and the gray line represents the extremes of intervention and non-intervention. PSE: Partial splenic embolization.

Figure 7 Overall survival data between the two groups in the follow-up. PSE: Partial splenic embolization.