Short-term Outcomes of Pancreatoduodenectomy in Patients with Liver Cirrhosis: A Systematic Review and Meta-analysis
Objectives:. The objective of this study was to compare short-term outcomes of pancreatoduodenectomy between patients with and without liver cirrhosis (LC). Background:. It is not uncommon to encounter a patient with LC and with an indication for pancreatoduodenectomy; however, the knowledge on the...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Health
2024-09-01
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| Series: | Annals of Surgery Open |
| Online Access: | http://journals.lww.com/10.1097/AS9.0000000000000454 |
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| author | Shahab Hajibandeh, MRCS Shahin Hajibandeh, FRCS Alwin Puthiyakunnel Saji Ayman Ashabi, MRCS Christopher Brown, FRCS Nicholas G Mowbray, FRCS Matthew Mortimer, FRCS Guy Shingler, FRCS Amir Kambal, FRCS Bilal Al-Sarireh, FRCS, PhD |
| author_facet | Shahab Hajibandeh, MRCS Shahin Hajibandeh, FRCS Alwin Puthiyakunnel Saji Ayman Ashabi, MRCS Christopher Brown, FRCS Nicholas G Mowbray, FRCS Matthew Mortimer, FRCS Guy Shingler, FRCS Amir Kambal, FRCS Bilal Al-Sarireh, FRCS, PhD |
| author_sort | Shahab Hajibandeh, MRCS |
| collection | DOAJ |
| description | Objectives:. The objective of this study was to compare short-term outcomes of pancreatoduodenectomy between patients with and without liver cirrhosis (LC).
Background:. It is not uncommon to encounter a patient with LC and with an indication for pancreatoduodenectomy; however, the knowledge on the outcomes after pancreatoduodenectomy in patients with LC is poorly developed.
Methods:. A systematic review and meta-analysis was conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement standards. Short-term outcomes of pancreatoduodenectomy between patients with and without LC were compared using random effects modeling and the certainty of the evidence was assessed using the GRADE system.
Results:. Analysis of 18,184 patients from 11 studies suggested LC increased the risk of postoperative mortality (odds ratio [OR]: 3.94, P < 0.00001), major complications (OR: 2.25, P = 0.0002), and pancreatic fistula (OR: 1.73, P = 0.03); it resulted in more blood loss (mean difference [MD]: 204.74 ml, P = 0.0003) and longer hospital stay (MD: 2.05 days, P < 0.00001). LC did not affect delayed gastric emptying (OR: 1.33, P = 0.21), postoperative bleeding (OR: 1.28, P = 0.42), and operative time (MD: 3.47 minutes, P = 0.51). Among the patients with LC, Child-Pugh B or C class increased blood loss (MD: 293.33 ml, P < 0.00001), and portal hypertension increased postoperative mortality (OR: 2.41, P = 0.01); the other outcomes were not affected.
Conclusions:. Robust evidence with high certainty suggests LC of any severity with or without portal hypertension results in at least a fourfold increase in mortality and a twofold increase in morbidity after pancreatoduodenectomy. Whether such risks increase with the severity of the liver disease or decrease with optimization of underlying liver disease should be the focus of future research. |
| format | Article |
| id | doaj-art-c3c3ec2ca58d40638572117d8ffe974f |
| institution | Kabale University |
| issn | 2691-3593 |
| language | English |
| publishDate | 2024-09-01 |
| publisher | Wolters Kluwer Health |
| record_format | Article |
| series | Annals of Surgery Open |
| spelling | doaj-art-c3c3ec2ca58d40638572117d8ffe974f2025-01-24T09:18:48ZengWolters Kluwer HealthAnnals of Surgery Open2691-35932024-09-0153e45410.1097/AS9.0000000000000454202409000-00002Short-term Outcomes of Pancreatoduodenectomy in Patients with Liver Cirrhosis: A Systematic Review and Meta-analysisShahab Hajibandeh, MRCS0Shahin Hajibandeh, FRCS1Alwin Puthiyakunnel Saji2Ayman Ashabi, MRCS3Christopher Brown, FRCS4Nicholas G Mowbray, FRCS5Matthew Mortimer, FRCS6Guy Shingler, FRCS7Amir Kambal, FRCS8Bilal Al-Sarireh, FRCS, PhD9From the * Department of Hepatobiliary and Pancreatic Surgery, Morriston Hospital, Swansea, UK† Department of Hepatobiliary and Pancreatic Surgery, Royal Stoke University Hospital, Stoke-on-Trent, UK‡ School of Medicine, Cardiff University, Cardiff, UKFrom the * Department of Hepatobiliary and Pancreatic Surgery, Morriston Hospital, Swansea, UKFrom the * Department of Hepatobiliary and Pancreatic Surgery, Morriston Hospital, Swansea, UKFrom the * Department of Hepatobiliary and Pancreatic Surgery, Morriston Hospital, Swansea, UKFrom the * Department of Hepatobiliary and Pancreatic Surgery, Morriston Hospital, Swansea, UKFrom the * Department of Hepatobiliary and Pancreatic Surgery, Morriston Hospital, Swansea, UKFrom the * Department of Hepatobiliary and Pancreatic Surgery, Morriston Hospital, Swansea, UKFrom the * Department of Hepatobiliary and Pancreatic Surgery, Morriston Hospital, Swansea, UKObjectives:. The objective of this study was to compare short-term outcomes of pancreatoduodenectomy between patients with and without liver cirrhosis (LC). Background:. It is not uncommon to encounter a patient with LC and with an indication for pancreatoduodenectomy; however, the knowledge on the outcomes after pancreatoduodenectomy in patients with LC is poorly developed. Methods:. A systematic review and meta-analysis was conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement standards. Short-term outcomes of pancreatoduodenectomy between patients with and without LC were compared using random effects modeling and the certainty of the evidence was assessed using the GRADE system. Results:. Analysis of 18,184 patients from 11 studies suggested LC increased the risk of postoperative mortality (odds ratio [OR]: 3.94, P < 0.00001), major complications (OR: 2.25, P = 0.0002), and pancreatic fistula (OR: 1.73, P = 0.03); it resulted in more blood loss (mean difference [MD]: 204.74 ml, P = 0.0003) and longer hospital stay (MD: 2.05 days, P < 0.00001). LC did not affect delayed gastric emptying (OR: 1.33, P = 0.21), postoperative bleeding (OR: 1.28, P = 0.42), and operative time (MD: 3.47 minutes, P = 0.51). Among the patients with LC, Child-Pugh B or C class increased blood loss (MD: 293.33 ml, P < 0.00001), and portal hypertension increased postoperative mortality (OR: 2.41, P = 0.01); the other outcomes were not affected. Conclusions:. Robust evidence with high certainty suggests LC of any severity with or without portal hypertension results in at least a fourfold increase in mortality and a twofold increase in morbidity after pancreatoduodenectomy. Whether such risks increase with the severity of the liver disease or decrease with optimization of underlying liver disease should be the focus of future research.http://journals.lww.com/10.1097/AS9.0000000000000454 |
| spellingShingle | Shahab Hajibandeh, MRCS Shahin Hajibandeh, FRCS Alwin Puthiyakunnel Saji Ayman Ashabi, MRCS Christopher Brown, FRCS Nicholas G Mowbray, FRCS Matthew Mortimer, FRCS Guy Shingler, FRCS Amir Kambal, FRCS Bilal Al-Sarireh, FRCS, PhD Short-term Outcomes of Pancreatoduodenectomy in Patients with Liver Cirrhosis: A Systematic Review and Meta-analysis Annals of Surgery Open |
| title | Short-term Outcomes of Pancreatoduodenectomy in Patients with Liver Cirrhosis: A Systematic Review and Meta-analysis |
| title_full | Short-term Outcomes of Pancreatoduodenectomy in Patients with Liver Cirrhosis: A Systematic Review and Meta-analysis |
| title_fullStr | Short-term Outcomes of Pancreatoduodenectomy in Patients with Liver Cirrhosis: A Systematic Review and Meta-analysis |
| title_full_unstemmed | Short-term Outcomes of Pancreatoduodenectomy in Patients with Liver Cirrhosis: A Systematic Review and Meta-analysis |
| title_short | Short-term Outcomes of Pancreatoduodenectomy in Patients with Liver Cirrhosis: A Systematic Review and Meta-analysis |
| title_sort | short term outcomes of pancreatoduodenectomy in patients with liver cirrhosis a systematic review and meta analysis |
| url | http://journals.lww.com/10.1097/AS9.0000000000000454 |
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