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Pancreatic Surgery in Patients with Cirrhosis

Chapter

Abstract

Pancreatic disease is a relatively common problem in the setting of cirrhosis or liver transplantation. The role of pancreatic surgery in this high-risk population must be carefully considered due to unique complications related to physiological changes associated with these operations. The management strategies for pancreatic malignancies have advanced significantly in recent decades, although the role of these treatment options in the setting of cirrhosis or liver transplantation remains limited based upon the limited experience gained over this time frame. Furthermore, although advances in chemotherapy options for these malignancies have increased survival for the general population, the safety of these treatments in cirrhotic or liver transplant patients has yet to be evaluated. Cystic lesions of the pancreas pose additional challenges in this population due to the uncertain fate of many of these lesions. Newer management strategies aimed at limiting surgical intervention for cystic lesions can be applied to better identify those patients with the highest risk for progression to invasive malignancies. Finally, chronic pancreatitis principles in the cirrhotic or liver transplant population are oftentimes nonoperative, given significant surgical risks unique to the cirrhotic population. In contrast, those patients with prior liver transplantation may be approached with a more standard treatment algorithm using a multidisciplinary operative and nonoperative approach. Advances in endoscopic therapies for palliation of these patients hold significant promise toward care of these chronic pancreatitis patients. This chapter focuses on synthesizing existing evidence and experience gained in the management and surgical decision-making for cirrhotic and liver transplantation patients.

Keywords

Pancreatic diseases Pancreatic neoplasms Pancreatic cyst Pancreatitis Pancreatectomy Pancreaticoduodenectomy Liver cirrhosis Liver diseases 

Recommended References

  1. 1.
    Busquets J, Pelaez N, Gil M, et al. Is pancreaticoduodenectomy a safe procedure in the cirrhotic patient? Cir Esp. 2016;94:385–91.CrossRefPubMedGoogle Scholar
  2. 2.
    Darstein F, Konig C, Hoppe-Lotichius M, et al. Impact of pancreatic comorbidities in patients with end-stage liver disease on outcome after liver transplantation. Eur J Intern Med. 2014;25:281–5.CrossRefPubMedGoogle Scholar
  3. 3.
    El Nakeeb A, Sultan AM, Salah T, et al. Impact of cirrhosis on surgical outcome after pancreaticoduodenectomy. World J Gastroenterol. 2013;19:7129–37.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Fuks D, Sabbagh C, Yzet T, Delcenserie R, Chatelain D, Regimbeau JM. Cirrhosis should not be considered as an absolute contraindication for pancreatoduodenectomy. Hepatogastroenterology. 2012;59:881–3.PubMedGoogle Scholar
  5. 5.
    Girometti R, Intini SG, Cereser L, et al. Incidental pancreatic cysts: a frequent finding in liver-transplanted patients as assessed by 3D T2-weighted turbo spin echo magnetic resonance cholangiopancreatography. JOP. 2009;10:507–14.PubMedGoogle Scholar
  6. 6.
    Lennon AM, Victor D, Zaheer A, et al. Liver transplant patients have a risk of progression similar to that of sporadic patients with branch duct intraductal papillary mucinous neoplasms. Liver Transpl. 2014;20:1462–7.PubMedPubMedCentralGoogle Scholar
  7. 7.
    Macinga P, Kautznerova D, Fronek J, Trunecka P, Spicak J, Hucl T. Pancreatic cystic lesions in liver transplant recipients: prevalence and outcome. Pancreatology. 2016;3:S105.CrossRefGoogle Scholar
  8. 8.
    Mejia J, Sucandy I, Steel J, et al. Indications and outcomes of pancreatic surgery after liver transplantation. Clin Transplant. 2014;28:330–6.CrossRefPubMedGoogle Scholar
  9. 9.
    Ngamruengphong S, Seeger KM, McCrone LM, et al. Prevalence and outcomes of cystic lesion of the pancreas in immunosuppressed patients with solid organ transplantation. Dig Liver Dis. 2015;47:417–22.CrossRefPubMedGoogle Scholar
  10. 10.
    Regimbeau JM, Rebibo L, Dokmak S, et al. 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. J Surg Oncol. 2015;111:776–83.CrossRefPubMedGoogle Scholar
  11. 11.
    Stauffer JA, Steers JL, Bonatti H, et al. Liver transplantation and pancreatic resection: a single-center experience and a review of the literature. Liver Transpl. 2009;15:1728–37.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Cleveland Clinic FoundationClevelandUSA
  2. 2.Department of General Surgery, Academic Department of SurgeryCleveland Clinic FoundationClevelandUSA

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