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

Abstract

Currently, safety of laparoscopic pancreaticoduodenectomy (LPD) in patients with liver cirrhosis is unknown. The aim of this study was to explore postoperative morbidity and mortality and long-term outcomes of cirrhotic patients after LPD. The study was a one-center retrospective study comprising 353 patients who underwent LPD between October 2010 and December 2019. A total of 28 patients had liver cirrhosis and were paired with 56 non-cirrhotic counterparts through propensity score matching (PSM). Baseline data, intra-operative data, postoperative data, and survival data were collected. Postoperative morbidity was considered as primary outcome whereas postoperative mortality, surgical parameters (operative durations, intraoperative blood loss), and long-term overall survival were secondary outcomes. Cirrhotic patients showed postoperative complication rates of 82% compared with rates of patients in the control group (48%) (P = 0.003). Further, Clavien-Dindo ≥III complication rates of 14% and 11% (P = 0.634), Clavien-Dindo I-II complication rates of 68% and 38% (P = 0.009), hospital mortality of 4% and 2% (P = 0.613) were observed for cirrhotic patients and non-cirrhotic patients, respectively. In addition, an overall survival rate of 32 months and 34.5 months (P = 0.991), intraoperative blood loss of 300 (200–400) ml and 150 (100–250) ml (P<0.0001), drain amount of 2572.5 (1023.8–5275) ml and 1617.5 (907.5–2700) ml (P = 0.048) were observed in the cirrhotic group and control group, respectively. In conclusion, LPD is associated with increased risk of postoperative morbidity in patients with liver cirrhosis. However, the incidence of Clavien-Dindo ≥III complications and post-operative mortality showed no significant increase. In addition, liver cirrhosis showed no correlation with poor overall survival in patients who underwent LPD. These findings imply that liver cirrhosis patients can routinely be considered for LPD at high volume centers with rigorous selection and management.

Outcome of Pancreaticoduodenectomy in Cirrhotic Patients

“…Postoperative pancreatic fistula (POPF) is more common in patients with hepatic cirrhosis, and portal hypertension (pHTN) is linked to intraoperative bleeding and blood transfusions (8,9) . The primary purpose of this study was to evaluate the efficacy of pancreaticoduodenectomy for cirrhotic patients treated at the National Liver Institute at Menoufia University.…”

Chronic Liver Disease Increases Mortality Following Pancreatoduodenectomy

“…To the best of our knowledge, this is the first study investigating common postoperative complications after PD in patients with LC and advanced LF according to the ISGPS definitions, with special emphasis on DGE, including DGE grading and specific parameters associated with DGE. There are several studies investigating postoperative complications and outcomes after PD in cirrhotic patients [ 16 , 17 , 33 , 34 , 35 ]. However, these studies show some limitations.…”

“…However, these studies show some limitations. First, and by far most importantly, almost all of the studies [ 16 , 17 , 33 , 34 , 35 ] include patient data before the year 2007—the year in which the International Study Group of Pancreatic Surgery developed a uniform definition of DGE, with DGE being further classified into three different grades (grade A, B and C) according to the clinical impact [ 29 ]. Thus, data were either only retrospectively classified according to ISGPS, or not at all, and sub-classification into grade A, B and C did not take place.…”

“…Thus, data were either only retrospectively classified according to ISGPS, or not at all, and sub-classification into grade A, B and C did not take place. One recent study by Cheng et al investigated the outcome of minimally invasive PD; in their propensity matched analysis, no difference in DGE was found in patients with and without higher-grade liver pathologies [ 35 ]. The ISGPS definition of DGE and the sub-classification into these grades involves either the postoperative duration of an NGT or the need for the reinsertion of an NGT [ 29 ].…”