IMPACT OF LIVER CIRRHOSIS ON SURGICAL COMPLICATIONS, TIME TO RECURRENCE, AND OVERALL SURVIVAL FOLLOWING RESECTION OF PANCREATIC DUCTAL ADENOCARCINOMA: A PROPENSITY-MATCHED STUDY
Maximiliano Servin-Rojas*, Gabriella Lionetto, Cristina R. Ferrone, Carlos Fernandez-Del Castillo, Andrew L. Warshaw, Keith D. Lillemoe, Motaz Qadan
Massachusetts General Hospital, Boston, MA
Introduction
Treatment of pancreatic ductal adenocarcinoma (PDAC) can be challenging in the setting of liver cirrhosis. We sought to evaluate the effect of cirrhosis on surgical complications, time to recurrence (TTR), and overall survival (OS) following the resection of PDAC in cirrhotic patients.
Methods
This was a single-center retrospective analysis of patients who underwent curative-intent resection for PDAC. Patients with a preoperative diagnosis of cirrhosis were compared to non-cirrhotic patients. Propensity score matching (PSM) was performed using the AJCC 8th edition TNM stage, preoperative serum level of CA 19-9, and surgical margin status. Postoperative complications, TTR, and OS were analyzed before and after PSM.
Results
We identified 1243 patients who fulfilled the inclusion criteria. Thirty-six patients (2%) had liver cirrhosis (80% Child-Pugh A, 17% Child-Pugh B, 3% Child-Pugh C) with an overall median MELD-Na of 11 (IQR 7.5-12.5) and were matched to 36 non-cirrhotic controls. After PSM, patients with cirrhosis had higher estimated blood loss (1000 ml, IQR 675-1600 vs. 650 ml, IQR 390-900, p=0.003), higher rates of major complications (42% vs. 12%, p=0.005), and a higher 30-day readmission rate (28% vs. 9%, p=0.042) than non-cirrhotic patients. No differences were found in TTR between both groups. However, median OS was substantially lower in patients with cirrhosis (14 months, 95% CI 11-20 vs. 33 months, 95% CI 20-not reached, p<0.001).
Conclusion
Patients with liver cirrhosis are at an increased risk of postoperative complications and associated with substantially worse survival following surgical resection of PDAC. Therefore, individualized risk-benefit assessment and multidisciplinary counseling are needed prior to consideration of pancreatectomy.
Time to recurrence and overall survival following resection of pancreatic ductal adenocarcinoma.
Postoperative complications before and after propensity score matching.
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