The impact of cirrhosis on short and long postoperative outcomes after distal pancreatectomy

• Published in: Surgery 2024-08, Vol.176 (2), p.447-454
• Main Authors: Coinsin, Benjamin, Durin, Thibault, Marchese, Ugo, Sauvanet, Alain, Dokmak, Safi, Cherkaoui, Zineb, Fuks, David, Laurent, Christophe, Magallon, Cloe, Turrini, Olivier, Sulpice, Laurent, Robin, Fabien, Bachellier, Philippe, Addeo, Piettro, Birnbaum, David Jérémie, Roussel, Edouard, Schwarz, Lilian, Regimbeau, Jean-Marc, Piessen, Guillaume, Liddo, Guido, Girard, Edouard, Cailliau, Émeline, Truant, Stéphanie, El Amrani, Mehdi
• Format: Article
• Language: English
• Subjects: Adenocarcinoma - complications; Adenocarcinoma - mortality; Adenocarcinoma - surgery; Aged; Female; Human health and pathology; Humans; Hépatology and Gastroenterology; Life Sciences; Liver Cirrhosis - complications; Liver Cirrhosis - mortality; Liver Cirrhosis - surgery; Male; Middle Aged; Operative Time; Pancreatectomy - adverse effects; Pancreatic Neoplasms - complications; Pancreatic Neoplasms - mortality; Pancreatic Neoplasms - surgery; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Retrospective Studies; Surgery; Survival Rate; Treatment Outcome
• ISSN: 0039-6060; 1532-7361; 1532-7361
• DOI: 10.1016/j.surg.2024.03.038

The impact of cirrhosis on the postoperative outcomes of distal pancreatectomy is yet to be reported. We aimed to evaluate the outcomes of distal pancreatectomy in patients with cirrhosis. We conducted a retrospective, multicentric study patients with cirrhosis who underwent planned distal pancreatectomy between 2008 and 2020 in French high volume centers. Patients with cirrhosis were matched 1:4 for demographic, surgical, and histologic criteria with patients without cirrhosis. The primary endpoint was severe morbidity (Clavien-Dindo grade ≥III). The secondary endpoints were postoperative complications, specifically related to cirrhosis and pancreatic surgery, and survival for patients with pancreatic adenocarcinoma. Overall, 32 patients with cirrhosis were matched with 128 patients without cirrhosis. Most patients (93.5%) had Child-Pugh A cirrhosis. The severe morbidity rate after distal pancreatectomy was higher in patients with cirrhosis than in those without cirrhosis (28.13% vs 25.75%, P = .11. The operative time was significantly longer in the cirrhotic group compared with controls (P = .01). However, patients with and without cirrhosis had comparable blood loss and conversion rates. Postoperatively, the two groups had similar rates of pancreatic fistula, hemorrhage, reoperation, postoperative mortality, and survival rates at 1, 3, and 5 years. The current study suggests that distal pancreatectomy in high-volume centers is feasible for patients with compensated cirrhosis.