Impact of cirrhosis on surgical outcome after pancreaticoduodenectomy

Nakeeb, Ayman El; Sultan, Ahmed; Salah, Tarek; Hemaly, Mohamed El; Hamdy, Emad; Salem, Ali; Moneer, Ahmed; Said, Rami; AbuEleneen, Ahmed; Zeid, Mostafa Abu; Abdallah, Talaat; Wahab, Mohamed Abdel

doi:10.3748/wjg.v19.i41.7129

Cited by 46 publications

(52 citation statements)

References 41 publications

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“…Pancreatic surgery is performed only in select cirrhotic patients. Nevertheless, an increasing number of case series show good results in select patients 457…”

Section: Discussionmentioning

confidence: 99%

“…The main difficulty was the presence of portal hypertension due to liver cirrhosis Child A. Previous studies indicated poorer outcomes in cirrhotic patients with portal hypertension 79. Transjugular intrahepatic portosystemic shunt before abdominal surgery does not improve postoperative evolution after abdominal surgery in cirrhotic patients 10…”

Section: Discussionmentioning

confidence: 99%

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Distal pancreatectomy with splenorenal shunt to preserve spleen in a cirrhotic patient

Ettorre

Sandri

Colasanti

et al. 2017

Ann Hepatobiliary Pancreat Surg

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At pancreatic ductal adenocarcinoma is an aggressive malignancy with a high recurrence rate. Due to its high potentials of local invasion and distant metastasis, surgical resection is the only means for possible long-term survival. Surgical treatment comprises a distal pancreatectomy with or without splenectomy. Surgery has been conventionally contraindicated for patients with cirrhosis and portal vein hepato-biliary hypertension. Splenorenal shunt was first described by Warren and colleagues, to prevent death from bleeding esophageal varices in a patient with a patent portal vein hypertension. A 55-year-old Caucasian woman presented with an incidental pancreatic tumor. In our case, the shunt was necessary to complete the corrective oncological surgery for pancreatic ductal adenocarcinoma. The main difficulty was the presence of portal hypertension due to liver cirrhosis Child A; moreover, preservation of the spleen was mandatory in this patient. We successfully performed a distal pancreatectomy without splenectomy through the help of splenorenal shunt to preserve venous circulation.

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“…Pancreatic surgery is performed only in select cirrhotic patients. Nevertheless, an increasing number of case series show good results in select patients 457…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Distal pancreatectomy with splenorenal shunt to preserve spleen in a cirrhotic patient

Ettorre

Sandri

Colasanti

et al. 2017

Ann Hepatobiliary Pancreat Surg

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“…These studies demonstrated that the Child–Pugh classification was a prognostic factor of mortality and morbidity, which have been reported as 4% and 79%, respectively, in Child class A, and 55% and 100% respectively, in Child class B . Those recent studies suggest that LC should not be considered as an absolute contraindication to PD, particularly in patients with Child–Pugh A cirrhosis . However, it remains uncertain whether or not the Child–Pugh classification is sufficient to assess the risk of PD, and currently, there are no other prognostic or predictive factors other than the Child–Pugh score.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of pancreaticoduodenectomy in patients with chronic hepatic dysfunction including liver cirrhosis: results of a retrospective multicenter study by the Japanese Society of Hepato‐Biliary‐Pancreatic Surgery

Futagawa

Yanaga

Kosuge³

et al. 2019

J Hepato Biliary Pancreat

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Background Since there is no reliable evidence on the safety of pancreaticoduodenectomy (PD) in chronic hepatic dysfunction (CHD) including liver cirrhosis (LC), the effects of CHD on patients undergoing PD were investigated. Methods This multi‐institutional retrospective study analyzed 529 patients with CHD, including 105 patients diagnosed with LC, who underwent PD at 82 high‐volume institutions between 2004 and 2013. Results The in‐hospital mortality rate was 5.9%. The incidence of postoperative hepatic decompensation upon discharge and refractory ascites was 10.2% and 8.9%, respectively. For hepatic decompensation, the serum aspartate aminotransferase (AST) of more than 50 IU/l and portal hypertension (PHT) were independent significant risk factors. For refractory ascites, prothrombin activity of <70%, serum AST of more than 50 IU/l and advanced PHT with collaterals were significant risk factors. Five‐year overall survival was 57.8% in Child A and 24.8% in Child B patients (P < 0.0001). The Child B/C patients were divided into two groups according to an AST‐platelet ratio index (APRI) of 1.0; the APRI of <1.0 yielded a significantly higher survival rate than their counterpart (43.2% vs. 14.7%, P = 0.04). Conclusions In addition to PHT, pre‐operative evaluation of AST and APRI may be helpful for patient selection for PD in patients with CHD.

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“…Pancreaticoduodenectomy (PD) alone is a high-risk surgery for malignant pancreatic and periampullary disease, including some benign lesions, with an operative mortality of 5%, and postoperative complication ranging from 30-60%, even without LC [197,199]. 2013 study: Overall colorectal surgery mortality was 8.7% (non-liver disease) vs. 13.3% (non-cirrhotics), and 24.1% (cirrhotics) [203].…”

Section: Gastricmentioning

confidence: 99%

“…Pancreatic 2013 study: Cirrhotics are at risk for higher amount of statistically significant intraoperative blood loss of over 500 ml (P=0.015) [197].…”

Section: Gastricmentioning

confidence: 99%

Perioperative Risk Assessment and Management of Cirrhotic Patients

AL¹,

Dong²,

Nayi³

2015

J Hepatol Gastroint Dis

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Liver cirrhosis is an important risk factor for morbidity and mortality in any type of surgical procedure. For these patients, a distinct and tailored patient optimization approach prior to surgery is required in order to best risk mitigate towards avoiding decompensation and related complications, especially with the chronicity of this disease. This review is to enhance understanding of surgical risks in these patients in selecting patients for elective surgery, or managing those following emergency surgery.

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Impact of cirrhosis on surgical outcome after pancreaticoduodenectomy

Cited by 46 publications

References 41 publications

Distal pancreatectomy with splenorenal shunt to preserve spleen in a cirrhotic patient

Distal pancreatectomy with splenorenal shunt to preserve spleen in a cirrhotic patient

Outcomes of pancreaticoduodenectomy in patients with chronic hepatic dysfunction including liver cirrhosis: results of a retrospective multicenter study by the Japanese Society of Hepato‐Biliary‐Pancreatic Surgery

Perioperative Risk Assessment and Management of Cirrhotic Patients

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