The Impact of Cirrhosis on Pancreatic Cancer Surgery: A Systematic Review and Meta-Analysis
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SCIENTIFIC REVIEW
The Impact of Cirrhosis on Pancreatic Cancer Surgery: A Systematic Review and Meta-Analysis Dimitrios Schizas1 • Spyridon Peppas2 • Stefanos Giannopoulos3 • Vasiliki Lagopoulou3 • Konstantinos S. Mylonas1 • Spyridon Giannopoulos1 • Dimitrios Moris4 • Evangelos Felekouras1 • Konstantinos Toutouzas5
Accepted: 4 October 2020 Ó Socie´te´ Internationale de Chirurgie 2020
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.
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00268-020-05821-7) contains supplementary material, which is available to authorized users. & Dimitrios Schizas [email protected] 1
First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
2
Department of Gastroenterology, Athens Naval Hospital, Athens, Greece
3
Department of Surgery, 251 VA and Hellenic Air Force Hospital, Athens, Greece
4
Department of Surgery, Duke University Medical Center, Durham, NC, USA
5
First Propedeutic Department of Surgery, Hippocration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
123
World J Surg
Introduction Cirrhosis represents a chronic debilitating disorder with substantial morbidity and mortality [1]. In Western societies, the main causes of cirrhosis are viral hepatitis infections, heavy alcohol consumption, and non-alcoholic liver disease [2]. Historically, cirrhos
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