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World journal of surgery
Feb, 2021;45 (2): 562-570.

The Impact of Cirrhosis on Pancreatic Cancer Surgery: A Systematic Review and Meta-Analysis.

Dimitrios Schizas, Spyridon Peppas, Stefanos Giannopoulos, Vasiliki Lagopoulou, Konstantinos S Mylonas, Spyridon Giannopoulos, Dimitrios Moris, Evangelos Felekouras, Konstantinos Toutouzas
Author Information
  1. Dimitrios Schizas: First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece. schizasad@gmail.com.
  2. Spyridon Peppas: Department of Gastroenterology, Athens Naval Hospital, Athens, Greece.
  3. Stefanos Giannopoulos: Department of Surgery, 251 VA and Hellenic Air Force Hospital, Athens, Greece.
  4. Vasiliki Lagopoulou: Department of Surgery, 251 VA and Hellenic Air Force Hospital, Athens, Greece.
  5. Konstantinos S Mylonas: First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece.
  6. Spyridon Giannopoulos: First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece.
  7. Dimitrios Moris: Department of Surgery, Duke University Medical Center, Durham, NC, USA.
  8. Evangelos Felekouras: First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece.
  9. Konstantinos Toutouzas: First Propedeutic Department of Surgery, Hippocration General Hospital, National and Kapodistrian University of Athens, Athens, Greece.
PMID: 33073316 DOI: 10.1007/s00268-020-05821-7

Abstract

BACKGROUND: Cirrhosis has been considered a contraindication to major abdominal surgeries, due to increased risk for postoperative morbidity and mortality. The aim of this study was to assess the safety of pancreatectomy in cirrhotic versus non-cirrhotic patients.
METHODS: The present systematic review and meta-analysis was performed according to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. All meta-analyses were performed using the random effects model.
RESULTS: Eight studies were eventually included, enrolling 1229 patients (cirrhotics: 722; and Child-Pugh A: 593; Child-Pugh B/C: 129) who underwent surgery for pancreatic cancer. The overall postoperative morbidity rate was 66% (51%-80%). Infections (26%) and ascites formation/worsening (23%) were the most common postoperative complications, followed by anastomotic leak/fistula (17%). Non-cirrhotic patients were less likely to suffer from anastomotic leak/fistula (OR: 0.39; 95% CI: 0.23-0.65) and infections (OR: 0.41; 95% CI: 0.25-0.67). Postoperative mortality rate was statistically significantly lower in non-cirrhotic versus cirrhotic patients (OR: 0.18; 95% CI:0.18-0.39). The odds ratios of 1 year (OR: 0.62; 95% CI: 0.30-1.30), 2 year (OR: 0.67; 95% CI: 0.25-1.83) and 3 year all-cause mortality (OR: 0.32; 95% CI: 20.03-2.99) were not significantly different between cirrhotic versus non-cirrhotic patients.
CONCLUSION: This study demonstrated that non-cirrhotic patients were less likely to undergo any type of re-intervention and had statistically significant lower postoperative mortality rates compared to patients with cirrhosis.

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MeSH Term

Esophagectomy
Humans
Liver Cirrhosis
Pancreatectomy
Pancreatic Neoplasms
Reoperation
Comparative Study Journal Article Meta-Analysis Systematic Review
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