High-risk liver patients are not associated with adverse events following pancreaticoduodenectomy

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 contra-indication for oncologic resection of pancreatic adenocarcinoma.