Safety of Pancreatic Surgery in Patients with Simultaneous Liver Cirrhosis: A Single Center Experience

Warnick, Peter; Mai, Ivo; Klein, Fritz; Ανδρέου, Ανδρέας; Bahra, Marcus; Neuhaus, P.; Glanemann, Matthias

doi:10.1159/000323961

Cited by 37 publications

(30 citation statements)

References 31 publications

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“…A case-control study by Warnick et al [52] compared outcomes in 32 cirrhotic patients (30 CTP A and 2 CTP B) vs. matched controls (operated patients without cirrhosis) undergoing pancreatic resection surgery. In their study, patients with cirrhosis experienced significantly more complications especially major complications (47 vs. 22%; p = 0.035) requiring reoperation (34 vs. 12%; p = 0.039).…”

Section: Pancreatic Surgerymentioning

confidence: 99%

Assessment of risk for non-hepatic surgery in cirrhotic patients

Bhangui¹,

Laurent²,

Amathieu³

et al. 2012

Journal of Hepatology

112

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Section: Pancreatic Surgerymentioning

confidence: 99%

Assessment of risk for non-hepatic surgery in cirrhotic patients

Bhangui¹,

Laurent²,

Amathieu³

et al. 2012

Journal of Hepatology

112

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“…2011 study: Cirrhotics have a higher complication rate (47% vs. 22%, P=0.035), reoperation requirements (34% vs. 12%, P=0.039), and prolonged hospital stay (28 vs. 24 days) during which required twice the ICU stay and twice as many transfusions [198].…”

Section: Gastricmentioning

confidence: 98%

Perioperative Risk Assessment and Management of Cirrhotic Patients

AL¹,

Dong²,

Nayi³

2015

J Hepatol Gastroint Dis

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Liver cirrhosis is an important risk factor for morbidity and mortality in any type of surgical procedure. For these patients, a distinct and tailored patient optimization approach prior to surgery is required in order to best risk mitigate towards avoiding decompensation and related complications, especially with the chronicity of this disease. This review is to enhance understanding of surgical risks in these patients in selecting patients for elective surgery, or managing those following emergency surgery.

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“…A wide range of interventions can be performed laparoscopically in LC patients: splenectomies, colectomies, Nissen fundoplication, Heller's myotomy, gastric bypass, radical nephrectomy [88] , appendectomies [89] , suture closure, and placement of an omental patch for treatment of a perforated gastric ulcer [90] . Although, in general, outcomes are poorer in LC patients than in the non-LC population in terms of morbidity and mortality, mortality rates are quite similar in certain surgeries thanks to the technical advances and experience gained in recent years (Table 3) [10,[77][78][79][81][82][83][84][85][86][87]89,[91][92][93][94][95][96][97][98][99][100][101] . One example is abdominal wall surgery.…”

Section: Surgical Considerationsmentioning

confidence: 99%

“…Application of ultrasonic energy via harmonic scalpel Use of argon beam coagulator through an operative port Laparoscopic hernia repair Belli et al [81] , 2006 Minimally invasive and tension-free laparoscopic technique Prevent inadvertent puncture of collateral veins Prevent recurrence rates and wound infections McAlister et al [82] , 2003 Dual mesh prosthesis: fixation of mesh in a preperitoneal space Prevent recurrence rates and mesh migration Sterile fashion of mesh insertion Prevent wound infections population and improves quality of life [81,82,[100][101][102][103][104][105][106][107][108][109][110] .…”

Section: Facilitate Haemostasismentioning

confidence: 99%

“…14%-29% (20.9%-35.8% if ES) 5% Radical gastric surgery [99] 56% (53.3% CTP A, 67.7% CTP B) -80% (5-yr) Appendectomy [87,89] Laparotomy 5% 9% 0.7% Laparoscopy < 1% < 1% < 1% Pancreatic surgery [100] 69% (67% CTP A, 100% CTP B) 9% (3% CTP A, 100% CTP B) -Abdominal wall surgery [81,82,[101][102][103][104][105][106][107][108][109][110] Umbilical hernia 7%-20% < 1%-5.5% < 1% Inguinal hernia 6.3%-10.9% < 1%-2.7% < 1%…”

Section: %mentioning

confidence: 99%

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Outcomes of abdominal surgery in patients with liver cirrhosis

López-Delgado

Ballús

Esteve

et al. 2016

WJG

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Patients suffering from liver cirrhosis (LC) frequently require non-hepatic abdominal surgery, even before liver transplantation. LC is an important risk factor itself for surgery, due to the higher than average associated morbidity and mortality. This high surgical risk occurs because of the pathophysiology of liver disease itself and to the presence of contributing factors, such as coagulopathy, poor nutritional status, adaptive immune dysfunction, cirrhotic cardiomyopathy, and renal and pulmonary dysfunction, which all lead to poor outcomes. Careful evaluation of these factors and the degree of liver disease can help to reduce the development of complications both during and after abdominal surgery. In the emergency setting, with the presence of decompensated LC, alcoholic hepatitis, severe/advanced LC, and significant extrahepatic organ dysfunction conservative management is preferred. A multidisciplinary, individualized, and s p e c i a l i z e d a p p r o a c h c a n i m p r o v e o u t c o m e s ; preoperative optimization after risk stratification and careful management are mandatory before surgery. Laparoscopic techniques can also improve outcomes. We review the impact of LC on surgical outcome in non-hepatic abdominal surgeries required in this cirrhotic population before, during, and after surgery.Key words: Liver cirrhosis; Outcomes; Coagulopathy; Nutritional status; Abdominal surgery; Adaptive levels of expertise of the surgeons, anesthetists, and intensive care unit (ICU) staff. Liver function is usually assessed by the Child-Turcott-Pugh (CTP) and Model for End-Stage Liver Disease (MELD) scores [11] . Early studies found 30 d mortality rates after surgery were 10% in CTP-A, 30% in CTP-B, and 76%-82% in CTP-C, figures that have not significantly changed in more recent assessments [12,13] . Despite the poor results, advances in the medical management of LC and life expectancy have increased the eligibility of these patients for abdominal surgery [14] . To be able to give definitive recommendations and indications for non-hepatic abdominal surgery in the cirrhotic population, it is important to identify the patients most likely to benefit from it. There is also a need to assess contemporary surgical techniques and the various scoring systems currently in use.This review summarizes the outcomes of patients with LC undergoing non-hepatic abdominal surgery. Indexed articles in Medline of series of patients with LC who underwent non-hepatic abdominal surgery between 1950 and March 2014 were reviewed using the OVID interface. We aimed to select manuscripts addressing outcome based on the degree of LC assessed with MELD and/or CTP scores. Articles addressing the pathophysiology of cirrhotic patients and the clinical implications in non-hepatic abdominal surgery were selected based on their importance, their date of publication, and the citations of the manuscripts. As for articles describing the different types of surgery in LC patients, the most recent publications were selected in order to preser...

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Safety of Pancreatic Surgery in Patients with Simultaneous Liver Cirrhosis: A Single Center Experience

Cited by 37 publications

References 31 publications

Assessment of risk for non-hepatic surgery in cirrhotic patients

Assessment of risk for non-hepatic surgery in cirrhotic patients

Perioperative Risk Assessment and Management of Cirrhotic Patients

Outcomes of abdominal surgery in patients with liver cirrhosis

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