Original Research Article| Volume 225, ISSUE 4, P735-739, April 2023

High-risk liver patients are not associated with adverse events following pancreaticoduodenectomy

Published:November 12, 2022DOI:


      • This is a retrospective analysis of the American College of Surgeons (ACS) National Surgical Quality Improvement Project (NSQIP) database evaluating the outcomes of high-risk liver patients undergoing a pancreaticoduodenectomy.
      • Previous publications have suggested high-risk liver patients are prone to increased adverse events however this analysis provides a contradicting finding that there is no increased adverse events for that patient population.
      • Patients with underlying high-risk liver disease do not necessarily pose a contraindication to pancreaticoduodenectomy, however more definitive research is required.


      Pancreaticoduodenectomy performed with underlying hepatic disease has been reported to have increased adverse events postoperatively. This study aimed to further evaluate that association.


      Retrospective review of the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) main and targeted pancreatectomy registries for 2014–2016. High-risk liver patients were defined by MELD scores, received neoadjuvant chemotherapy, and had hepatosteatosis; two separate subgroups of MELD ≥9 and ≥ 11. High-risk liver patients were then compared to control cases via propensity score matching.


      There were 156 and 132 cases that met the high-risk liver criteria for the MELD cutoffs of ≥9 and ≥ 11 respectively. Propensity score matching left 2527 cases for final adjusted analysis. On both univariate and multivariate analysis high-risk liver patients were not associated with increased adverse events following Whipple resection. Lack of association with increased adverse events held for both the ≥9 and ≥ 11 MELD score cohorts.


      High-risk liver patients defined by MELD scores, neoadjuvant chemotherapy utilization, and hepatosteatosis were not associated with any increased incidence of adverse events following pancreaticoduodenectomy. Patients with underlying high-risk liver disease in this study did not appear to pose as a contraindication for oncologic resection of pancreatic adenocarcinoma.

      Graphical abstract

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