Spleen volume-to-platelet count ratio correlates with portal pressure and is associated with blood loss in laparoscopic non-anatomical hepatectomy

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 (≥ 10 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 = 0.811, p < 0.01). 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 ≥ 11.3 had greater blood loss than those with SVPR < 11.3 (107.5 vs 40 mL, p = 0.011), with a rank-biserial correlation of 0.401 (95% bootstrap CI, 0.109–0.661). 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.