{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T01:46:24Z","timestamp":1775785584300,"version":"3.50.1"},"reference-count":41,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2019,6,19]],"date-time":"2019-06-19T00:00:00Z","timestamp":1560902400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Hepato Biliary Pancreat"],"published-print":{"date-parts":[[2019,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Since there is no reliable evidence on the safety of pancreaticoduodenectomy (<jats:styled-content style=\"fixed-case\">PD<\/jats:styled-content>) in chronic hepatic dysfunction (<jats:styled-content style=\"fixed-case\">CHD<\/jats:styled-content>) including liver cirrhosis (<jats:styled-content style=\"fixed-case\">LC<\/jats:styled-content>), the effects of <jats:styled-content style=\"fixed-case\">CHD<\/jats:styled-content> on patients undergoing <jats:styled-content style=\"fixed-case\">PD<\/jats:styled-content> were investigated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This multi\u2010institutional retrospective study analyzed 529 patients with <jats:styled-content style=\"fixed-case\">CHD<\/jats:styled-content>, including 105 patients diagnosed with <jats:styled-content style=\"fixed-case\">LC<\/jats:styled-content>, who underwent <jats:styled-content style=\"fixed-case\">PD<\/jats:styled-content> at 82 high\u2010volume institutions between 2004 and 2013.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The in\u2010hospital mortality rate was 5.9%. The incidence of postoperative hepatic decompensation upon discharge and refractory ascites was 10.2% and 8.9%, respectively. For hepatic decompensation, the serum aspartate aminotransferase (<jats:styled-content style=\"fixed-case\">AST<\/jats:styled-content>) of more than 50\u00a0IU\/l and portal hypertension (<jats:styled-content style=\"fixed-case\">PHT<\/jats:styled-content>) were independent significant risk factors. For refractory ascites, prothrombin activity of &lt;70%, serum <jats:styled-content style=\"fixed-case\">AST<\/jats:styled-content> of more than 50\u00a0IU\/l and advanced <jats:styled-content style=\"fixed-case\">PHT<\/jats:styled-content> with collaterals were significant risk factors. Five\u2010year overall survival was 57.8% in Child A and 24.8% in Child B patients (<jats:italic>P<\/jats:italic> &lt; 0.0001). The Child B\/C patients were divided into two groups according to an AST\u2010platelet ratio index (<jats:styled-content style=\"fixed-case\">APRI<\/jats:styled-content>) of 1.0; the <jats:styled-content style=\"fixed-case\">APRI<\/jats:styled-content> of &lt;1.0 yielded a significantly higher survival rate than their counterpart (43.2% vs. 14.7%, <jats:italic>P<\/jats:italic> = 0.04).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In addition to <jats:styled-content style=\"fixed-case\">PHT<\/jats:styled-content>, pre\u2010operative evaluation of <jats:styled-content style=\"fixed-case\">AST<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">APRI<\/jats:styled-content> may be helpful for patient selection for <jats:styled-content style=\"fixed-case\">PD<\/jats:styled-content> in patients with <jats:styled-content style=\"fixed-case\">CHD<\/jats:styled-content>.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jhbp.630","type":"journal-article","created":{"date-parts":[[2019,4,24]],"date-time":"2019-04-24T15:51:51Z","timestamp":1556121111000},"page":"310-324","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Outcomes of pancreaticoduodenectomy in patients with chronic hepatic dysfunction including liver cirrhosis: results of a retrospective multicenter study by the Japanese Society of Hepato\u2010Biliary\u2010Pancreatic Surgery"],"prefix":"10.1002","volume":"26","author":[{"given":"Yasuro","family":"Futagawa","sequence":"first","affiliation":[{"name":"Department of Surgery The Jikei University School o f Medicine 3\u201025\u20108 Nishishimbashi, Minato\u2010ku Tokyo 105\u20108461 Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katsuhiko","family":"Yanaga","sequence":"additional","affiliation":[{"name":"Department 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