@article{3120062,
    title = "The Impact of Cirrhosis on Pancreatic Cancer Surgery: A Systematic Review and Meta-Analysis",
    author = "Schizas, D. and Peppas, S. and Giannopoulos, S. and Lagopoulou, V. and Mylonas, K.S. and Giannopoulos, S. and Moris, D. and Felekouras, E. and Toutouzas, K.",
    journal = "World Journal of Surgery",
    year = "2021",
    volume = "45",
    number = "2",
    pages = "562-570",
    publisher = "Springer Science and Business Media Deutschland GmbH",
    issn = "0364-2313, 1432-2323",
    doi = "10.1007/s00268-020-05821-7",
    keywords = "adverse event;  comparative study;  complication;  esophagus resection;  human;  liver cirrhosis;  meta analysis;  mortality;  pancreas tumor;  pancreatectomy;  reoperation, Esophagectomy;  Humans;  Liver Cirrhosis;  Pancreatectomy;  Pancreatic Neoplasms;  Reoperation",
    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. © 2020, Société Internationale de Chirurgie."
}