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

Abstract

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.

Safety of laparoscopic pancreaticoduodenectomy in patients with liver cirrhosis using propensity score matching

“…In addition, 11 (39%) patients were diagnosed with Child-Pugh A liver function, 17 (61%) patients were diagnosed with Child-Pugh B liver function and none was diagnosed with Child-Pugh C liver function. Median MELD score was 12 (8)(9)(10)(11)(12)(13)(14)(15)(16)(17). The cirrhotic group showed no statistical difference in baseline conditions compared with the control group.…”

“…cirrhosis is not a risk factor for longer operative time. Several studies report the effect of cirrhosis on the surgical outcome of PD [16][17][18][19]. However, currently, no reports on post-operation morbidity and mortality of patients with liver cirrhosis after undergoing LPD.…”

“…Incidence of liver cirrhosis patients included in this study, who underwent LPD was 7.93%. Other studies report that between 1.9 and 15.2% of patients receiving PD are diagnosed with liver cirrhosis [16][17][18][19].…”

“…Although a few previous studies reported on outcomes of PD in patients with liver cirrhosis, the safety of LPD procedure has not been explored previously [16][17][18][19]. PD and LPD procedures have several differences; therefore, it is necessary to explore short-and long-term outcomes of LPD in patients with liver cirrhosis.…”

The Impact of Cirrhosis on Pancreatic Cancer Surgery: A Systematic Review and Meta‐Analysis

“…That said, currently, there are no established prognostic factors, except for Child-Pugh classification, that could accurately risk-stratify and guide treatment in cirrhotic patients. As a result, the decision for undergoing PD in a cirrhotic patient largely relies on the experience of the surgeon and the institution [18][19][20][21][22][23][24].…”