The Short- and Long-term Outcomes of Pancreaticoduodenectomy for Cancer in Child a Patients Are Acceptable: a Patient-control Study from the Surgical French Association Report for Pancreatic Surgery

BackgroundOn the basis of now dated studies, cirrhosis is usually considered to be a contraindication in pancreatoduodenectomy (PD) for adenocarcinoma of the pancreatic head (APH). ObjectiveExamine the outcomes of PD for APH in the presence of cirrhosis. MethodsRetrospective, multicenter study of cirrhotic patients with APH having undergone PD between January 2004 and March 2012. Cirrhotic patients were matched 1:2 for demographic, surgical and histologic criteria with non-cirrhotic patients. Primary endpoint was morbidity and mortality. Secondary endpoints were surgical parameters, morbidity related to pancreatic surgery and cirrhosis, and follow-up. ResultsWe included 35 patients with cirrhosis. Twenty-four patients (69%) were Child A and none were Child C. The Child A cirrhotic patients and non-cirrhotic patients respectively had complication rates of 79% vs. 43% (P=0.002), major complication rates of 33% vs. 21% (P=0.26), pancreatic fistula rates of 13% vs. 9% (P=0.57), post-operative mortality of 4% vs. 5% (P=0.94), 3-year overall survival rates of 44% vs. 50% (P=0.46). All Child B cirrhotic patients experienced post-operative complications. ConclusionPancreatoduodenectomy for APH was possible in Child A cirrhotic patients with a mortality and long-term outcomes equivalent to non-cirrhotic patients. Child B cirrhosis remains a clear contraindication to surgery. J. Surg. Oncol. 2015 111:776-783. (c) 2015 Wiley Periodicals, Inc. J. Surg. Oncol. 2015 111:776-783. (c) 2015 Wiley Periodicals, Inc.