Highlights
- •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.
Introduction
Pancreaticoduodenectomy performed with underlying hepatic disease has been reported
to have increased adverse events postoperatively. This study aimed to further evaluate
that association.
Methods
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.
Results
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.
Conclusion
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
Graphical Abstract
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Article info
Publication history
Published online: November 12, 2022
Accepted:
November 7,
2022
Received in revised form:
October 26,
2022
Received:
September 29,
2022
Identification
Copyright
Published by Elsevier Inc.
