Quantity and quality of survival after portosystemic shunts

Preoperative Parameters Influencing Survival in Patients with Elective Portacaval Shunts

“…This conclusion is in accord with the findings of Foster el al. [3] and of T urcotte and Lambert [10] but is contrary to the experience of FIermann et ai. [4,5] who found that ad vancing age limited survival and who recommended restricting the number of shunts performed in patients 60 years of age or older.…”

“…Its value as a prophylactic measure aimed at preventing bleeding of esophagogastric varices has been called in question; it indeed reduces the risk of bleeding, but it does not improve longevity [1], There is general consensus that it is effective as a therapeutic procedure for preventing recurrence of bleeding [3,6], but wide variation in survival rates has been noted and attempts have in consequence been made to identify and assess clinical variables liable to influence mortal ity. Careful selection of patients for portal-systemic shunts is said to be essential for maximum survival [4], Yet, too rigorous a selection would result in the operation being reserved for patients with a high resistance to…”

Prognostic Significance of Serum Bile Acids in Cirrhosis

“…Before and since the introduction of the Child classification and its modifications (13)(14)(15)(16)(17), a number of authors described prognostic models (18)(19)(20)(21)(22)(23)(24)(25)(26) based on as few as one (27) and as many as 17 components (ll), but some of these models are so complex that they are clinically impractical (28). Until now, the Child classification and its modifications are by far the most widely used and reported system to describe the prognosis of patients with cirrhosis of the liver.…”

Portal-Systemic Shunts in Patients with Cirrhosis

“…This surgical procedure was considered beneficial [10, 44. 78] for the following reasons: ( I) the posthemorrhagic mortality in patients with cirrho sis is very high [23,59]; (2) after one hemorrhage the risk of recurrence has been reported to be high [2]; each recurrence is said to have a high death rate [2]; (3) in patients with portacaval shunt, digestive hemorrhage is rare [30]; (4) operative mortality is moderate (10% or less) [78]; (5) the 5-year survival rate of patients with alcoholic cirrhosis and portacaval shunt ranges from 30 to 50% [3,27,51,78,88]. These arguments suggest the following remarks: (1) the posthemorrhagic mortality in patients with cirrhosis without portacaval shunt reported in the medical literature concerns all the patients with cirrho sis and hemorrhage whatever the degree of hepatic impairment: the natural history of digestive bleedingsand of survival in patients in whom a shunt could have been indicated and has not been performed is poorly known; (2) from four retrospective studies [14,25,66,81] including 142 patients, the 5-year survival rate of patients who were proposed for a surgical procedure and who have not been operated on for unclear reasons is near 35%.…”

“…On clinical and biological findings, patients are usually divided into three groups, so-called 'good, mild and poor operative risk' [10,34], The age of patients is a criteria for some authors [34,39,84], not for others [11,27,51,80], Neither the volume of oesophageal varices [63,65] nor the free hepatic venous pressure -wedged hepatic venous pressure (or free portal venous pressure) gradient had never been taken into consideration [73] until recently [42]. The fact that the source of the bleeding is either a rupture of oesophag eal varices or acute gastric erosions has not been, until now, a criteria to perform or not a shunt [79], The aetiology of cirrhosis could be of prognostic significance; for instance the 5-year survival rate in patients with portacaval shunt and alcoholic cirrhosis is 30-50% [3, 27.…”