Surgery in cirrhotic patients in malignancy provokes scepticism and pessimism among clinicians due to mortality rates as high as 25% . In our study we looked at morbidity and mortality associated with these patients and present a positive perspective.
A data analysis of patients with cirrhosis, who underwent surgery for non-hepatic malignancy during the period January 2011 to December 2016, was done. Child Turcot Pugh (CTP) and Model for End stage Liver Disease (MELD) scores, various intraoperative parameters, perioperative morbidity (Clavien Dindo classification), mortality and hospital stay were recorded.
40 patients with cirrhosis underwent surgery for non-hepatic malignancy. Emergency surgery was done in 6 patients. 26 patients were CTP grade A, 13 patients were grade B and 11 patients had grade C. Mean MELD score was 9.5 ±4.2. Overall mean operating time was 4.6 ±2.4 hours and blood loss was 305 ± 150 ml. In these patients, median blood transfusion requirement was 2 (1-5) PRBC. Overall morbidity was 26% but major morbidity (Clavien Dindo III) was seen in 5 patients (12.5%). Perioperative mortality occurred in 2 patients (5%). Patients who underwent surgery in emergency had more morbidity (n = 2,33%) and mortality (n = 1,16%) (p = <0.001).
In cirrhotic patients who undergo surgery for non-hepatic malignancy the factors associated with poor outcomes are emergency surgery, higher CTP grade and MELD score irrespective of type of malignancy. In these patients meticulous perioperative management can lead to excellent results and we need to shun negative attitudes while formulating a management plan for them.
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All authors have declared no conflicts of interest.