Impact of cirrhosis on surgical outcome after pancreaticoduodenectomy

Table 1 Demographic data for cirrhotic patients n (%)

Variables	Statistics
Number	67 (15.2)
Age
Mean (yr)	54.07 ± 9.43
< 60 yr	48 (71.6)
> 60 yr	19 (28.4)
Sex
Male	52 (77.6)
Female	15 (22.4)
Cause
HCV	44 (65.7)
HBV	8 (11.9)
Combined	5 (7.5)
Pure periportal fibrosis	10 (14.9)
Child classification
Child A	63 (94)
Child B (patient's score less than 8)	4 (6)
With portal hypertension	16 (23.9)
Without portal hypertension	51 (76.1)

HCV: Hepatitis C virus; HBV: Hepatitis B virus.

Table 2 Preoperative data n (%)

Variables	Cirrhotic group	Non cirrhotic group	P value
	Group A	Group B
Age
Mean (yr)	54.07 ± 9.43	52.47 ± 10.73	NS
< 60 yr	48 (71.6)	286 (76.3)	NS
> 60 yr	19 (28.4)	89 (23.7)
Sex
Male	52 (77.6)	225 (60)	0.006
Female	15 (22.4)	150 (40)
BMI
< 25	53 (79.1)	285 (76)	NS
> 25	14 (20.9)	90 (24)
Preoperative albumin (gm%)	3.69 ± 0.5	3.96 ± 0.48	0.01
Preoperative SGPT (IU/L)	71.68 ± 45.74	77.4 ± 71.29	NS
Preoperative bilirubin (mg%)	6.72 ± 8.01	8.79 ± 8.9	NS
Preoperative HG (gm/dL)	13.26 ± 11.57	13.43 ± 13.05	NS
Preoperative CEA
Mean (ng/mL)	67.31 ± 69.78	30.97 ± 62.57	0.0001
< 5 ng/mL	14 (20.9)	182 (48.5)	0.0001
> 5 ng/mL	53 (79.1)	193 (51.5)
Preoperative CA19-9
Mean (U/mL)	103.89 ± 202.18	100.23 ± 208.85	NS
< 37 U/mL	35 (52.2)	207 (55.2)	NS
> 37 U/mL	32 (47.8)	168 (44.8)
Preoperative ERCP	42 (62.7)	231 (50.4)	NS

NS: Not significant; BMI: Body mass index; ERCP: Endoscopic retrograde cholangio-pancreatography; SGPT: Alanine transaminase.

Table 3 Operative data n (%)

Variables	Cirrhotic group	Non cirrhotic group	P value
	Group A	Group B
Median blood loss (mL)	500 (100-2500)	200 (50-2000)	0.0001
< 500 mL	31 (46.3)	233 (62.1)	0.01
> 500 mL	36 (53.7)	142 (37.9)
Blood transfusion
Median (unite)	1 (0-4)	0 (0-4)	0.0001
Number of patients	38 (56.7)	145 (38.7)	0.006
Tumour size
Mean (cm)	2.61 ± 1.2	2.82 ± 1.13	NS
< 2 cm	33 (49.3)	144 (38.4)
> 2 cm	34 (50.7)	231 (61.6)
Pancreatic texture
Soft	48 (71.6)	246 (65.6)	NS
Firm	19 (28.4)	129 (34.4)
Pancreatic duct diameter
Mean (mm)	4.04 ± 2.96	4.24 ± 2.68	NS
< 3 mm	39 (58.2)	208 (55.5)	NS
> 3 mm	28 (41.8)	195 (44.5)
Site of tumour
Ampullary	25 (37.3)	116 (30.9)
Pancreatic head mass	34 (50.7)	222 (59.2)	NS
Cholangiocarcinoma	2 (3)	13 (3.5)
Duodenal tumour	6 (9)	24 (6.4)
Operative time (h)	5.81 ± 0.87	5.1 ± 0.99	0.0001

NS: Not significant.

Table 4 Postoperative data n (%)

Variables	Cirrhotic group	Non cirrhotic group	P value
	Group A	Group B
Time to resume oral intake (d)	5.98 ± 5.11	6.08 ± 5.71	NS
Drain removal (d)	11.2 ± 9.89	9.41 ± 6.76	NS
Drain amount (mL)	1106.76 ± 1388.91	676.42 ± 1871.36	NS
Complications
Pancreatic fistula	13 (19.4)	37 (9.9)	0.02
Grade A	5 (7.5)	16 (4.3)
Grade B	3 (4.5)	15 (4)	NS
Grade C	5 (7.5)	6 (1.6)
Delayed gastric emptying	10 (14.9)	41 (10.9)	NS
Biliary leakage	4 (6)	19 (5.1)	NS
Wound infection	10 (14.9)	24 (6.4)	0.02
Burst wound	4 (6)	2 (0.5)	0.0001
Internal haemorrhage	4 (6)	7 (1.9)	0.05
Bleeding gastrojejunostomy	1 (1.5)	12 (3.2)	NS
Bleeding pancreaticogastrostomy	1 (1.5)	6 (1.6)	NS
Abdominal collection	12 (17.9)	40 (10.7)	NS
Encephalopathy	2 (3)	0	0.001
Ascites	7 (10.44)	0	0.0001
Re-exploration	8 (11.9)	27 (7.2)	NS
Postoperative albumin (gm%)	2.81 ± 0.56	2.97 ± 0.43	0.01
Postoperative bilirubin (mg%)	4.54 ± 5.1	3.54 ± 3.89	NS
Postoperative SGPT (IU/L)	113.08 ± 50.1	58.35 ± 82.1	0.0001
Hospital mortality	8 (11.9)	6 (1.6)	0.0001
Liver cell failure	4 (6)	0
Sepsis	4 (6)	4 (1)
Pulmonary embolism	0	2 (0.5%)
Postoperative stay (d)	12.97 ± 11.2	10.71 ± 7.41	0.03
Median survival (mo)	19	24	0.009
1 yr	42	59
2 yr	13	29
3 yr	8	19

NS: Not significant.

Table 5 Outcomes of cirrhotic patients n (%)

Variables	Cirrhotic Group	Patients without PHT (51 patients)	Patients with PHT (16 patients)	P values
Age
Mean (yr)	54.07 ± 9.43	54.66 ± 10.05	52.18 ± 7.04	NS
< 60 yr	48 (71.6)	35 (68.6)	13 (81.3)	NS
> 60 yr	19 (28.4)	16 (31.4)	3 (18.8)
Sex
Male	52 (77.6)	40 (78.4)	12 (75)	NS
Female	15 (22.4)	11 (21.6)	4 (25)
Median blood loss (mL)	500 (100-2500)	300 (100-2500)	1000 (200-2500)	0.001
< 500 mL	31 (46.3)	26 (51)	5 (31.3)	NS
> 500 mL	36 (53.7)	25 (49)	11 (68.8)
Blood transfusion
Median (unite)	1 (0-4)	1 (0-4)	2 (0-4)	0.020
Number of patients	38 (56.7)	26 (51)	12 (75)
Operative time (h)	5.81 ± 0.87	5.8 ± 0.91	5.68 ± 0.72	NS
Hospital stay (d)	12.97 ± 11.2	14.5 ± 10.2	12.49 ± 11.55	NS
Pancreatic fistula	13 (19.4)	7 (13.7)	6 (37.5)	NS
Grade A	5 (7.5)	3 (5.9)	2 (12.5)	NS
Grade B	3 (4.5)	1 (2)	2 (12.5)
Grade C	5 (7.5)	3 (5.9)	2 (12.5)
Delayed gastric emptying	10 (14.9)	6 (11.8)	4 (25)	NS
Biliary leakage	4 (6)	3 (5.9)	1 (6.3)	NS
Wound infection	10 (14.9)	6 (11.8)	4 (25)	NS
Burst wound	4 (6)	2 (3.9)	2 (12.5)	NS
Internal haemorrhage	4 (6)	3 (5.9)	1 (6.3)	NS
Bleeding gastrojejunostomy	1 (1.5)	0	1 (6.3)	NS
Bleeding pancreaticogastrostomy	1 (1.5)	0	1 (6.3)	NS
Abdominal collection	12 (17.9)	8 (15.7)	4 (25)	NS
Encephalopathy	2 (3)	1 (2)	1 (6.3)	NS
Ascites	7 (10.44)	4 (7.8)	3 (18.8)	NS
Re-exploration	8 (11.9)	4 (7.8)	4 (25)	NS
Hospital mortality	8 (11.9)	4 (7.8)	4 (25)	NS
Liver cell failure	4 (6)	2 (3.9)	2 (12.5)
Sepsis	4 (6)	2 (3.9)	2 (12.5)
Pulmonary embolism	0
Median survival (mo)	19	21	18	NS
1 yr	42	41	46
2 yr	13	15	4
3 yr	8	9	0

NS: Not significant; PHT: Portal hypertension.