title: The short- and long-term outcomes of pancreaticoduodenectomy for cancer in Child A patients are acceptable: a patient-control study from the Surgical French Association report for pancreatic surgery.
abstract: BACKGROUND
  On the basis of now dated studies, cirrhosis is usually considered to be a contraindication in pancreatoduodenectomy (PD) for adenocarcinoma of the pancreatic head (APH).
  
  
  OBJECTIVE
  Examine the outcomes of PD for APH in the presence of cirrhosis.
  
  
  METHODS
  Retrospective, multicenter study of cirrhotic patients with APH having undergone PD between January 2004 and March 2012. Cirrhotic patients were matched 1:2 for demographic, surgical and histologic criteria with non-cirrhotic patients. Primary endpoint was morbidity and mortality. Secondary endpoints were surgical parameters, morbidity related to pancreatic surgery and cirrhosis, and follow-up.
  
  
  RESULTS
  We included 35 patients with cirrhosis. Twenty-four patients (69%) were Child A and none were Child C. The Child A cirrhotic patients and non-cirrhotic patients respectively had complication rates of 79% vs. 43% (P = 0.002), major complication rates of 33% vs. 21% (P = 0.26), pancreatic fistula rates of 13% vs. 9% (P = 0.57), post-operative mortality of 4% vs. 5% (P = 0.94), 3-year overall survival rates of 44% vs. 50% (P = 0.46). All Child B cirrhotic patients experienced post-operative complications.
  
  
  CONCLUSIONS
  Pancreatoduodenectomy for APH was possible in Child A cirrhotic patients with a mortality and long-term outcomes equivalent to non-cirrhotic patients. Child B cirrhosis remains a clear contraindication to surgery.
authors: Department of Digestive Surgery, Amiens University Medical Center and the Jules Verne University of Picardie, Amiens, France.
authors: Jean-Marc
authors: JM
authors: Regimbeau
authors: Lionel
authors: L
authors: Rebibo
authors: Safi
authors: S
authors: Dokmak
authors: Jean-Marie
authors: JM
authors: Boher
authors: Alain
authors: A
authors: Sauvanet
authors: Xavier
authors: X
authors: Chopin-Laly
authors: Mustapha
authors: M
authors: Adham
authors: Mickaël
authors: M
authors: Lesurtel
authors: Jean-Marc
authors: JM
authors: Bigourdan
authors: Stéphanie
authors: S
authors: Truant
authors: François-René
authors: FR
authors: Pruvot
authors: Pablo
authors: P
authors: Ortega-Deballon
authors: François
authors: F
authors: Paye
authors: Philippe
authors: P
authors: Bachellier
authors: Jean-Robert
authors: JR
authors: Delpero
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000401:mortality / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D016022:Case-Control Studies; D000075202:Contraindications; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications; D008103:Liver Cirrhosis / Q000145:classification* / Q000150:complications; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D061646:Operative Time; D010185:Pancreatic Fistula / Q000209:etiology; D010190:Pancreatic Neoplasms / Q000150:complications / Q000401:mortality / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D012189:Retrospective Studies; D012720:Severity of Illness Index
keywords: Child A; adenocarcinoma; cirrhosis; liver failure; pancreatoduodenectomy