title: Cirrhosis should not be considered as an absolute contraindication for pancreatoduodenectomy.
abstract: OBJECTIVE
  Liver cirrhosis is considered to be a contraindication for pancreaticoduodenectomy (PD). The aim of this study was to present 4 cases of successful PD in cirrhotic patients.
  
  
  METHODS
  Among the charts of 90 patients who underwent PD between 2004 and 2008, 4 patients with liver cirrhosis were retrospectively reviewed.
  
  
  RESULTS
  There were 3 males and 1 female, aged from 53 to 66 years, who underwent PD for pancreatic head adenocarcinoma (n=3) or ampullary carcinoma (n=1). The median tumor size was 21mm (18-26) and 2 patients had preoperative biliary drainage. All patients had biopsy showing cancer prior to the operation. Cirrhosis was preoperatively suspected due to chronic alcoholism or liver dismorphy on CTscan and confirmed histologically in all patients. All patients were Child Pugh A without portal hypertension. The median operating time was 575 minutes (480-600) and 2 patients received an intraoperative blood transfusion. No patient died postoperatively. All patients had postoperative complications: ascites (n=2), pancreatic fistula (soft pancreas) (n=2) and pulmonary infection (n=1). There was neither liver failure nor postoperative bleeding. Two patients required re-operation for suspected mesenteric ischemia (n=1) and pancreatic fistula (n=1). The median length of hospitalization was 50 days (41-74). The median survival was 12.5 months (3 patients are alive and disease free).
  
  
  CONCLUSIONS
  Our data shows that PD in patients with Child A liver cirrhosis should not be systematically considered as a contraindication.
authors.affiliation: Department of Digestive Surgery, Jules Verne University of Picardy, Amiens, France.
authors.forename: David
authors.initials: D
authors.lastname: Fuks
authors.forename: Charles
authors.initials: C
authors.lastname: Sabbagh
authors.forename: Thierry
authors.initials: T
authors.lastname: Yzet
authors.forename: Richard
authors.initials: R
authors.lastname: Delcenserie
authors.forename: Denis
authors.initials: D
authors.lastname: Chatelain
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Regimbeau
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000473:pathology / Q000601:surgery*; D000368:Aged; D001706:Biopsy; D001803:Blood Transfusion; D000075202:Contraindications; D018572:Disease-Free Survival; D005260:Female; D005602:France; D006801:Humans; D007902:Length of Stay; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications* / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D018579:Patient Selection; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome