Impact of cirrhosis on surgical outcome after pancreaticoduodenectomy.
OBJECTIVE
To elucidate surgical outcomes of pancreaticoduodenectomy (PD) in patients with liver cirrhosis.


METHODS
We studied retrospectively all patients who underwent PD in our centre between January 2002 and December 2011. Group A comprised patients with cirrhotic livers, and Group B comprised patients with non-cirrhotic livers. The cirrhotic patients had Child-Pugh classes A and B (patient's score less than 8). Preoperative demographic data, intra-operative data and postoperative details were collected. The primary outcome measure was hospital mortality rate. Secondary outcomes analysed included duration of the operation, postoperative hospital stay, postoperative morbidity and survival rate.


RESULTS
Only 67/442 patients (15.2%) had cirrhotic livers. Intraoperative blood loss and blood transfusion were significantly higher in group A (P = 0.0001). The mean surgical time in group A was significantly longer than that in group B (P = 0.0001). Wound complications (P = 0.02), internal haemorrhage (P = 0.05), pancreatic fistula (P = 0.02) and hospital mortality (P = 0.0001) were significantly higher in the cirrhotic patients. Postoperative stay was significantly longer in group A (P = 0.03). The median survival was 19 mo in group A and 24 mo in group B. Portal hypertension (PHT) was present in 16/67 cases of cirrhosis (23.9%). The intraoperative blood loss and blood transfusion were significantly higher in patients with PHT (P = 0.001). Postoperative morbidity (0.07) and hospital mortality (P = 0.007) were higher in cirrhotic patients with PHT.


CONCLUSIONS
Patients with periampullary tumours and well-compensated chronic liver disease should be routinely considered for PD at high volume centres with available expertise to manage liver cirrhosis. PD is associated with an increased risk of postoperative morbidity in patients with liver cirrhosis; therefore, it is only recommended in patients with Child A cirrhosis without portal hypertension.
Ayman El Nakeeb, Ahmad M Sultan, Tarek Salah, Mohamed El Hemaly, Emad Hamdy, Ali Salem, Ahmed Moneer, Rami Said, Ahmed AbuEleneen, Mostafa Abu Zeid, Talaat Abdallah, Mohamed Abdel Wahab, Gastroenterology surgical center, Mansoura University, Mansoura 35516, Egypt.
Ayman
A
El Nakeeb
Ahmad M
AM
Sultan
Tarek
T
Salah
Mohamed
M
El Hemaly
Emad
E
Hamdy
Ali
A
Salem
Ahmed
A
Moneer
Rami
R
Said
Ahmed
A
AbuEleneen
Mostafa
M
Abu Zeid
Talaat
T
Abdallah
Mohamed
M
Abdel Wahab
D000328:Adult; D016009:Chi-Square Distribution; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology / Q000401:mortality; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008103:Liver Cirrhosis / Q000150:complications* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000150:complications / Q000401:mortality / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000401:mortality; D018579:Patient Selection; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
Liver cirrhosis; Pancreaticoduodenectomy; Periampullary tumour; Portal hypertension