TY - JOUR
TI - The Impact of Cirrhosis on Pancreatic Cancer Surgery: A Systematic Review and Meta-Analysis
AU - Schizas, D.
AU - Peppas, S.
AU - Giannopoulos, S.
AU - Lagopoulou, V.
AU - Mylonas, K.S.
AU - Giannopoulos, S.
AU - Moris, D.
AU - Felekouras, E.
AU - Toutouzas, K.
JO - World Journal of Surgery
PY - 2021
VL - 45
TODO - 2
SP - 562-570
PB - Springer Science and Business Media Deutschland GmbH
SN - 0364-2313, 1432-2323
TODO - 10.1007/s00268-020-05821-7
TODO - 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
TODO - 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.
ER -