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

Abstract

Background Cirrhosis has been considered a contraindication to major abdominal surgeries, due to increased risk for postoperative morbidity and mortality. The aim of this study was to assess the safety of pancreatectomy in cirrhotic versus non-cirrhotic patients. Methods The present systematic review and meta-analysis was performed according to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. All meta-analyses were performed using the random effects model. Results Eight studies were eventually included, enrolling 1229 patients (cirrhotics: 722; and Child-Pugh A: 593; Child-Pugh B/C: 129) who underwent surgery for pancreatic cancer. The overall postoperative morbidity rate was 66% (51%-80%). Infections (26%) and ascites formation/worsening (23%) were the most common postoperative complications, followed by anastomotic leak/fistula (17%). Non-cirrhotic patients were less likely to suffer from anastomotic leak/fistula (OR: 0.39; 95% CI: 0.23-0.65) and infections (OR: 0.41; 95% CI: 0.25-0.67). Postoperative mortality rate was statistically significantly lower in non-cirrhotic versus cirrhotic patients (OR: 0.18; 95% CI:0.18-0.39). The odds ratios of 1 year (OR: 0.62; 95% CI: 0.30-1.30), 2 year (OR: 0.67; 95% CI: 0.25-1.83) and 3 year all-cause mortality (OR: 0.32; 95% CI: 20.03-2.99) were not significantly different between cirrhotic versus non-cirrhotic patients. Conclusion This study demonstrated that non-cirrhotic patients were less likely to undergo any type of re-intervention and had statistically significant lower postoperative mortality rates compared to patients with cirrhosis.

Gastrointestinal Cancers and Liver Cirrhosis: Implications on Treatments and Prognosis

“…There was a significant increase in wound complications, internal organ bleeding, pancreatic fistula, and hospital mortality in patients with cirrhosis (94). Schizas et al proposed that wound infection, ascites, and anastomosis leakage are the most common postoperative complications in patients with cirrhosis who undergo pancreatic cancer surgery, while non-cirrhosis patients are less likely to develop these complications (95). It is of great significance to consider postoperative complications in the treatment of patients with pancreatic cancer and cirrhosis.…”