SURGICAL MANAGEMENT OF NON-HEPATIC MALIGNANCY IN CIRRHOTIC PATIENTS: PERSPECTIVE BEYOND NIHILISM!! saurabh_galodha@yahoo.com

351-07

SURGICAL MANAGEMENT OF NON-HEPATIC MALIGNANCY IN CIRRHOTIC PATIENTS: PERSPECTIVE BEYOND NIHILISM!!

1

India

Oral only

A nihilistic view for surgery in cirrhotic patients with non-hepatic malignancy (NHM) is usually presented due to high mortality rates of up to 25%. We try to present a positive perspective in management of these patients.

Analysis of data of patients with cirrhosis with NHM who underwent surgery during period of January 2019 to December 2024 was done. Child Turcot Pugh (CTP) and Model for End stage Liver Disease (MELD) scores, intraoperative parameters, perioperative morbidity (Clavien Dindo classification), mortality and hospital stay were included in the analysis.

Study included 50 patients of cirrhosis undergoing surgery for NHM including colorectal, upper GI and periampullary malignancy. Emergency surgery was done in 6 patients. CTP grade A, B & C were present in 26 patients,13 patients and 11 patients respectively. Mean MELD score was 9.5 ± 4.2. Mean operating time was 4.6 ± 2.4 hours and mean blood loss of 305 ± 150 ml. Median blood transfusion requirement was 2 (1-5) PRBC. Overall morbidity was 26% but major morbidity (Clavien Dindo > 3) seen in 5 patients (12.5%) only. Perioperative mortality occurred in 2 patients (5%) with CTP grade C. Median hospital stay was 14 (7-28) days. Emergency surgery had more morbidity (n=2,33%) and mortality (n=1,16%) (p=<0.001).

Emergency surgery, higher CTP grade and higher MELD score is associated with poor outcomes in cirrhotic patients undergoing surgery for non-hepatic malignancy. Meticulous perioperative management leads to excellent results and we need to shun nihilistic attitude for these patients