{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T04:12:54Z","timestamp":1790395974808,"version":"4.1.0"},"reference-count":23,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T00:00:00Z","timestamp":1784073600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T00:00:00Z","timestamp":1784073600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100008702","name":"Kagoshima University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100008702","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Updates Surg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Portal hypertension increases bleeding risk during liver resection, but direct measurement is invasive and impractical in routine practice. Therefore, we investigated whether the spleen volume-to-platelet count ratio (SVPR), a non-invasive surrogate, correlates with portal pressure and is associated with blood loss during laparoscopic hepatectomy. The correlation between portal pressure and SVPR was examined in 20 patients undergoing open hepatectomy with direct portal pressure measurement. Receiver operating characteristic (ROC) curve analysis was used to determine the optimal SVPR cutoff for clinically significant portal hypertension (\u2265\u200910 mmHg) with bootstrap internal validation. We then retrospectively analyzed 131 laparoscopic hepatectomies, comparing anatomical and non-anatomical procedures stratified by the derived SVPR cutoff. SVPR was strongly correlated with portal pressure (r\u2009=\u20090.811,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.01). The apparent AUC was 0.979, with negligible bootstrap optimism (optimism-corrected AUC: 0.98); the Youden index-derived cutoff remained centered around 11.3. In the laparoscopic cohort, SVPR was independently associated with blood loss in non-anatomical hepatectomy in multivariable analysis, but not in anatomical hepatectomy. When stratified by the ROC-derived cutoff of 11.3, patients with SVPR\u2009\u2265\u200911.3 had greater blood loss than those with SVPR\u2009&lt;\u200911.3 (107.5 vs 40 mL,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.011), with a rank-biserial correlation of 0.401 (95% bootstrap CI, 0.109\u20130.661). The overall blood loss was modest, and no patient required perioperative blood transfusion. SVPR was correlated with portal pressure and associated with blood loss in laparoscopic non-anatomical hepatectomy, although the proposed cutoff remains exploratory and requires further validation.\n                  <\/jats:p>","DOI":"10.1007\/s13304-026-02775-8","type":"journal-article","created":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T16:01:28Z","timestamp":1784131288000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Spleen volume-to-platelet count ratio correlates with portal pressure and is associated with blood loss in laparoscopic non-anatomical hepatectomy"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2264-3619","authenticated-orcid":false,"given":"Yota","family":"Kawasaki","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoichi","family":"Yamasaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kosuke","family":"Fukuda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideyuki","family":"Oi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuto","family":"Hozaka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tetsuya","family":"Idichi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuko","family":"Mataki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takao","family":"Ohtsuka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,15]]},"reference":[{"key":"2775_CR1","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1007\/s00534-012-0555-1","volume":"20","author":"DW Hwang","year":"2013","unstructured":"Hwang DW, Han HS, Yoon YS et al (2013) Laparoscopic major liver resection in Korea: a multicenter study. J Hepatobiliary Pancreat Sci 20:125\u2013130. https:\/\/doi.org\/10.1007\/s00534-012-0555-1","journal-title":"J Hepatobiliary Pancreat Sci"},{"key":"2775_CR2","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1111\/ases.12768","volume":"13","author":"M Inomata","year":"2020","unstructured":"Inomata M, Shiroshita H, Uchida H et al (2020) Current status of endoscopic surgery in Japan: the 14th national survey of endoscopic surgery by the Japan Society for Endoscopic Surgery. Asian J Endosc Surg 13:7\u201318. https:\/\/doi.org\/10.1111\/ases.12768","journal-title":"Asian J Endosc Surg"},{"key":"2775_CR3","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1007\/s595-002-8112-0","volume":"32","author":"Y Nakajima","year":"2002","unstructured":"Nakajima Y, Shimamura T, Kamiyama T, Matsushida M, Sato N, Todo S (2002) Control of intraoperative bleeding during liver resection: analysis of a questionnaire sent to 231 Japanese hospitals. Surg Today 32:48\u201352. https:\/\/doi.org\/10.1007\/s595-002-8112-0","journal-title":"Surg Today"},{"key":"2775_CR4","doi-asserted-by":"publisher","first-page":"520","DOI":"10.1016\/S1499-3872(13)60082-X","volume":"12","author":"CX Lin","year":"2013","unstructured":"Lin CX, Guo Y, Lau WY et al (2013) Optimal central venous pressure during partial hepatectomy for hepatocellular carcinoma. Hepatobiliary Pancreat Dis Int 12:520\u2013524. https:\/\/doi.org\/10.1016\/S1499-3872(13)60082-X","journal-title":"Hepatobiliary Pancreat Dis Int"},{"key":"2775_CR5","doi-asserted-by":"publisher","first-page":"376","DOI":"10.1177\/0003134820949995","volume":"87","author":"D Imai","year":"2021","unstructured":"Imai D, Maeda T, Wang H et al (2021) Risk factors for and outcomes of intraoperative blood loss in liver resection for hepatocellular tumors. Am Surg 87:376\u2013383. https:\/\/doi.org\/10.1177\/0003134820949995","journal-title":"Am Surg"},{"key":"2775_CR6","doi-asserted-by":"publisher","first-page":"1200","DOI":"10.1136\/gut.52.8.1200","volume":"52","author":"E Giannini","year":"2003","unstructured":"Giannini E, Botta F, Borro P et al (2003) Platelet count\/spleen diameter ratio: proposal and validation of a non-invasive parameter to predict the presence of oesophageal varices in patients with liver cirrhosis. Gut 52:1200\u20131205. https:\/\/doi.org\/10.1136\/gut.52.8.1200","journal-title":"Gut"},{"key":"2775_CR7","doi-asserted-by":"publisher","first-page":"2511","DOI":"10.1111\/j.1572-0241.2006.00874.x","volume":"101","author":"E Giannini","year":"2006","unstructured":"Giannini E, Zaman A, Kreil A et al (2006) Platelet count\/spleen diameter ratio for the noninvasive diagnosis of esophageal varices: results of a multicenter, prospective, validation study. Am J Gastroenterol 101:2511\u20132519. https:\/\/doi.org\/10.1111\/j.1572-0241.2006.00874.x","journal-title":"Am J Gastroenterol"},{"key":"2775_CR8","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1053\/j.gastro.2012.10.001","volume":"144","author":"A Berzigotti","year":"2013","unstructured":"Berzigotti A, Seijo S, Arena U et al (2013) Elastography, spleen size, and platelet count identify portal hypertension in patients with compensated cirrhosis. Gastroenterology 144:102\u2013111. https:\/\/doi.org\/10.1053\/j.gastro.2012.10.001","journal-title":"Gastroenterology"},{"key":"2775_CR9","doi-asserted-by":"publisher","first-page":"998","DOI":"10.1186\/s40064-016-2708-1","volume":"5","author":"S Shibata","year":"2016","unstructured":"Shibata S, Joshita S, Umemura T et al (2016) Liver stiffness-spleen size-to-platelet ratio risk score detects esophageal varices in chronic liver disease. Springerplus 5:998. https:\/\/doi.org\/10.1186\/s40064-016-2708-1","journal-title":"Springerplus"},{"key":"2775_CR10","doi-asserted-by":"publisher","first-page":"884","DOI":"10.1111\/hepr.12631","volume":"46","author":"S Shibata","year":"2016","unstructured":"Shibata S, Umemura T, Yamazaki T et al (2016) Liver stiffness-spleen size-to-platelet ratio risk score identifies esophageal varices in Japanese patients with chronic hepatitis C. Hepatol Res 46:884\u2013889. https:\/\/doi.org\/10.1111\/hepr.12631","journal-title":"Hepatol Res"},{"key":"2775_CR11","doi-asserted-by":"publisher","first-page":"1029","DOI":"10.7150\/jca.15174","volume":"7","author":"M Sakoda","year":"2016","unstructured":"Sakoda M, Ueno S, Iino S et al (2016) Survival benefits of small anatomical resection of the liver for patients with hepatocellular carcinoma and impaired liver function, based on new-era imaging studies. J Cancer 7:1029\u20131036. https:\/\/doi.org\/10.7150\/jca.15174","journal-title":"J Cancer"},{"key":"2775_CR12","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1016\/S0928-4346(96)00325-8","volume":"6","author":"F Ichida","year":"1996","unstructured":"Ichida F, Tsuji T, Omata M et al (1996) New Inuyama classification for histological assessment of chronic hepatitis. Hepatol Commun 6:112\u2013119. https:\/\/doi.org\/10.1016\/S0928-4346(96)00325-8","journal-title":"Hepatol Commun"},{"key":"2775_CR13","doi-asserted-by":"publisher","first-page":"281","DOI":"10.21037\/hbsn.2016.03.03","volume":"5","author":"G Wakabayashi","year":"2016","unstructured":"Wakabayashi G (2016) What has changed after the Morioka consensus conference 2014 on laparoscopic liver resection? Hepatobiliary Surg Nutr 5:281\u2013289. https:\/\/doi.org\/10.21037\/hbsn.2016.03.03","journal-title":"Hepatobiliary Surg Nutr"},{"key":"2775_CR14","doi-asserted-by":"publisher","first-page":"359","DOI":"10.1111\/j.1365-2036.2007.03378.x","volume":"26","author":"D Thabut","year":"2007","unstructured":"Thabut D, Imbert-Bismut F, Cazals-Hatem D et al (2007) Relationship between the Fibrotest and portal hypertension in patients with liver disease. Aliment Pharmacol Ther 26:359\u2013368. https:\/\/doi.org\/10.1111\/j.1365-2036.2007.03378.x","journal-title":"Aliment Pharmacol Ther"},{"key":"2775_CR15","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1272\/jnms.JNMS.2023_90-104","volume":"90","author":"H Yoshida","year":"2023","unstructured":"Yoshida H, Shimizu T, Yoshioka M et al (2023) The role of the spleen in portal hypertension. J Nippon Med Sch 90:20\u201325. https:\/\/doi.org\/10.1272\/jnms.JNMS.2023_90-104","journal-title":"J Nippon Med Sch"},{"key":"2775_CR16","doi-asserted-by":"publisher","first-page":"960","DOI":"10.1148\/radiol.11110156","volume":"261","author":"M Hirooka","year":"2011","unstructured":"Hirooka M, Ochi H, Koizumi Y et al (2011) Splenic elasticity measured with real-time tissue elastography is a marker of portal hypertension. Radiology 261:960\u2013968. https:\/\/doi.org\/10.1148\/radiol.11110156","journal-title":"Radiology"},{"key":"2775_CR17","doi-asserted-by":"publisher","first-page":"646","DOI":"10.1053\/j.gastro.2012.05.035","volume":"143","author":"A Colecchia","year":"2012","unstructured":"Colecchia A, Montrone L, Scaioli E et al (2012) Measurement of spleen stiffness to evaluate portal hypertension and the presence of esophageal varices in patients with HCV-related cirrhosis. Gastroenterology 143:646\u2013654. https:\/\/doi.org\/10.1053\/j.gastro.2012.05.035","journal-title":"Gastroenterology"},{"key":"2775_CR18","doi-asserted-by":"publisher","first-page":"1394","DOI":"10.1007\/s00330-014-3124-y","volume":"24","author":"M Ronot","year":"2014","unstructured":"Ronot M, Lambert S, Elkrief L et al (2014) Assessment of portal hypertension and high-risk oesophageal varices with liver and spleen three-dimensional multifrequency MR elastography in liver cirrhosis. Eur Radiol 24:1394\u20131402. https:\/\/doi.org\/10.1007\/s00330-014-3124-y","journal-title":"Eur Radiol"},{"key":"2775_CR19","doi-asserted-by":"publisher","first-page":"1317","DOI":"10.1002\/hep.21178","volume":"43","author":"RK Sterling","year":"2006","unstructured":"Sterling RK, Lissen E, Clumeck N et al (2006) Development of a simple noninvasive index to predict significant fibrosis in patients with HIV\/HCV coinfection. Hepatology 43:1317\u20131325. https:\/\/doi.org\/10.1002\/hep.21178","journal-title":"Hepatology"},{"key":"2775_CR20","doi-asserted-by":"publisher","first-page":"546","DOI":"10.1111\/j.1478-3231.2009.02192.x","volume":"30","author":"BK Kim","year":"2010","unstructured":"Kim BK, Kim DY, Park JY et al (2010) Validation of FIB-4 and comparison with other simple noninvasive indices for predicting liver fibrosis and cirrhosis in hepatitis B virus-infected patients. Liver Int 30:546\u2013553. https:\/\/doi.org\/10.1111\/j.1478-3231.2009.02192.x","journal-title":"Liver Int"},{"key":"2775_CR21","doi-asserted-by":"publisher","first-page":"198","DOI":"10.1002\/hep.25599","volume":"56","author":"C Corpechot","year":"2012","unstructured":"Corpechot C, Carrat F, Poujol-Robert A et al (2012) Noninvasive elastography-based assessment of liver fibrosis progression and prognosis in primary biliary cirrhosis. Hepatology 56:198\u2013208. https:\/\/doi.org\/10.1002\/hep.25599","journal-title":"Hepatology"},{"key":"2775_CR22","doi-asserted-by":"publisher","first-page":"411","DOI":"10.1016\/j.dld.2015.02.001","volume":"47","author":"B Procopet","year":"2015","unstructured":"Procopet B, Mircea Cristea V, Robic MA et al (2015) Serum tests, liver stiffness and artificial neural networks for diagnosing cirrhosis and portal hypertension. Dig Liver Dis 47:411\u2013416. https:\/\/doi.org\/10.1016\/j.dld.2015.02.001","journal-title":"Dig Liver Dis"},{"key":"2775_CR23","doi-asserted-by":"publisher","first-page":"979","DOI":"10.14218\/JCTH.2021.00593","volume":"10","author":"SHH Nababan","year":"2022","unstructured":"Nababan SHH, Lesmana CRA (2022) Portal hypertension in nonalcoholic fatty liver disease: from pathogenesis to clinical practice. J Clin Transl Hepatol 10:979\u2013985. https:\/\/doi.org\/10.14218\/JCTH.2021.00593","journal-title":"J Clin Transl Hepatol"}],"container-title":["Updates in Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s13304-026-02775-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s13304-026-02775-8","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s13304-026-02775-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T16:01:29Z","timestamp":1784131289000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s13304-026-02775-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,15]]},"references-count":23,"alternative-id":["2775"],"URL":"https:\/\/doi.org\/10.1007\/s13304-026-02775-8","relation":{},"ISSN":["2038-131X","2038-3312"],"issn-type":[{"value":"2038-131X","type":"print"},{"value":"2038-3312","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,15]]},"assertion":[{"value":"28 March 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 July 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 July 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors have no relevant financial or non-financial interests to disclose.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was approved by the institutional review board of Kagoshima University (IRB No. 250047) and was performed in accordance with the ethical standards of the institutional research committee and the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.","order":2,"name":"Ethics","label":"Ethical approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Patient consent was obtained using an opt-out approach in accordance with institutional guidelines.","order":3,"name":"Ethics","label":"Consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}}]}}