title: Is pancreaticoduodenectomy a safe procedure in the cirrhotic patient?
abstract: BACKGROUND
  Pancreaticoduodenectomy (PD) is usually contraindicated in chronic liver disease. The objective of the present study was to analyze PD results in cirrhotic patients, and compare them with non-cirrhotic ones.
  
  
  METHODS
  Between 1994 and 2014 we prospectively collected all patients with a PD for periampullar neoplasms in Hospital Universitari de Bellvitge. We registered preoperative, intraoperative and postoperative variables. We defined patients undergoing PD with liver cirrhosis as the study group (CH group), and those without liver cirrhosis as the control group (NCH group). A case/control study was performed (1/2).
  
  
  RESULTS
  We registered 15 patients in the CH group, all with good liver function (Child A), and included 30 patients in NCH group. The causes of hepatopathy were HCV (60%) and alcoholism (40%). For the 3 moments studied, the CH group had a lower blood platelet count and a higher prothrombin ratio, compared with NCH group. Postoperative morbidity was 60% and mean postoperative stay was 25±19 days, with no differences in terms of complications between CH group and NCG group (73% vs. 53%, P=.1). Presence of ascites was higher in the CH group compared with NCH group (28 vs. 0%, P<.001). There were no differences in terms of hemorrhage or pancreatic fístula. Four patients of the CH group and 2 patients of the NCH group were reoperated on (26.7 vs. 6.7%, P=.1). There was no postoperative mortality.
  
  
  CONCLUSIONS
  PD is a safe procedure in cirrhotic patients with good liver function although it presents high morbidity.
authors.affiliation: Servei de Cirurgia General i Digestiva, Hospital Universitari de Bellvitge, Barcelona, España. Electronic address: jbusquets@bellvitgehospital.cat.
authors.forename: Juli
authors.initials: J
authors.lastname: Busquets
authors.affiliation: Servei de Cirurgia General i Digestiva, Hospital Universitari de Bellvitge, Barcelona, España.
authors.forename: Núria
authors.initials: N
authors.lastname: Peláez
authors.affiliation: Servei de Cirurgia General i Digestiva, Hospital Universitari de Bellvitge, Barcelona, España.
authors.forename: Marta
authors.initials: M
authors.lastname: Gil
authors.affiliation: Servei de Cirurgia General i Digestiva, Hospital Universitari de Bellvitge, Barcelona, España.
authors.forename: Lluís
authors.initials: L
authors.lastname: Secanella
authors.affiliation: Servei de Cirurgia General i Digestiva, Hospital Universitari de Bellvitge, Barcelona, España.
authors.forename: Emilio
authors.initials: E
authors.lastname: Ramos
authors.affiliation: Servei de Cirurgia General i Digestiva, Hospital Universitari de Bellvitge, Barcelona, España.
authors.forename: Laura
authors.initials: L
authors.lastname: Lladó
authors.affiliation: Servei de Cirurgia General i Digestiva, Hospital Universitari de Bellvitge, Barcelona, España.
authors.forename: Joan
authors.initials: J
authors.lastname: Fabregat
mesh_terms: D016022:Case-Control Studies; D000075204:Contraindications, Procedure; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000150:complications* / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects; D011446:Prospective Studies
keywords: Cirrosis hepática; Cirugía pancreática; Hepatic cirrhosis; Pancreatic surgery