LDLT has excellent outcomes in patients with EASL-CLIF grade 1 and 2 ACLF. Without transplantation, ACLF patients have a very poor prognosis.

Curative surgery may benefit some patients with pancreatic cancer and positive PALN and should be considered selectively.

Highlights Pancreaticodoudenectomy in cirrhotic patients is seldom attempted. It is associated with high morbidity and mortality rates. Careful patient selection allows its safe performance in cirrhotic patients. Preoperative biliary drainages should always be considered. Liver cirrhosis is not an absolute contraindication to PD.

Objective: Pancreaticodoudenectomy (PD) remains a challenging surgical procedure. PD outcomes remain under reported from Pakistan. The objective of the current study was to report PD outcomes from a large single center patient cohort. Methods: A total of 155 patients who underwent PD between 2011 and 2019 were included. Outcome was assessed based on morbidity, in hospital mortality and survival. Results: Mean age was 56.8 ±13.5 years (range=8-85). Male to female ratio was (103/52)1.9:1. Overall morbidity was 84/155 (54.2%). Grade B and C pancreatic fistula (PF) were seen in 5 (3.2%) and 6 (3.8%) patients. In hospital mortality was 5/155 (3.2%). The estimated 5 year overall survival (OS) was 11% and 23% for pancreatic and non-pancreatic cancers (P=0.2). The estimated 3 year OS was lower with multivisceral resection (23% vs 5%, P <0.001), advanced tumors (40% vs 11%)(P=0.008) , nodal involvement (34% vs 12%)(P=0.04) and positive microscopic margins (30% vs 8%, P=0.006). Conclusion: Short and long term outcomes comparable to international high volume centers for PD can be achieved with site specific focus in hepatopancreatobiliary surgery. Continuous...

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