Pancreaticoduodenectomy with radical lymphadenectomy is not contraindicated for patients with established chronic liver disease and portal hypertension.
BACKGROUND
Chronic liver disease has been considered a contraindication to radical surgery for intra-abdominal tumors because of the risk of decompensation.


METHODS
In a retrospective analysis of all patients undergoing pancreaticoduodenectomy for cancer treated from January 2000 to December 2006 at our center, 4 patients were identified with operable pancreatic tumors and well-compensated chronic liver disease. The preoperative staging, decompression of the biliary tree, liver biopsy, Child-Turcot-Pugh and MELD scores were described.


RESULTS
All patients underwent pancreaticoduodenectomy successfully with minimal blood loss, and no peri-operative blood transfusions or liver decompensation. There was no postoperative mortality. Two patients received adjuvant chemotherapy. One patient died with recurrent disease at 18 months, one is alive with disease recurrence, and two are alive and disease free.


CONCLUSIONS
Patients with pancreatic cancer and well-compensated chronic liver disease should routinely be considered for radical surgery at specialist hepatobiliary centres with expertise available to manage complex liver disease.
Sethi
Harsheet
H
Institute of Liver Studies, Kings College London School of Medicine at Kings College Hospital, Denmark Hill, London SE5 9RS, UK.
Srinivasan
Parthi
P
Marangoni
Gabriele
G
Prachalias
Andreas
A
Rela
Mohamed
M
Heaton
Nigel
N
D000008:Abdominal Neoplasms / Q000150:complications / Q000601:surgery*; D000328:Adult; D000368:Aged; D001201:Ascites / Q000150:complications / Q000628:therapy; D000075202:Contraindications; D005260:Female; D006521:Hepatitis, Chronic / Q000150:complications* / Q000628:therapy; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications* / Q000628:therapy; D008197:Lymph Node Excision / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy / Q000379:methods*; D018579:Patient Selection; D012189:Retrospective Studies; D016896:Treatment Outcome