{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T11:44:17Z","timestamp":1761997457979,"version":"build-2065373602"},"reference-count":11,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2017,7,17]],"date-time":"2017-07-17T00:00:00Z","timestamp":1500249600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2017,7,17]],"date-time":"2017-07-17T00:00:00Z","timestamp":1500249600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2017,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Chronic obstruction of the biliary system may cause hepatic fibrosis and liver failure. The purpose of this study was to define the incidence of unrecognized liver fibrosis in patients undergoing pancreaticoduodenectomy (PD).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Retrospective data were collected on patients undergoing PD during a 21\u2010month period. Each patient had a core needle biopsy at the time of surgery by a hepatobiliary surgeon.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>This study identified 36 consecutive patients who were referred to a tertiary center and underwent pancreatoduodenectomy during a period of 21\u00a0months. The majority of patients, 32 (88.8%), were diagnosed with pancreatic adenocarcinoma. Liver fibrosis was diagnosed in 23 (63.9%) patients. A total of 25 (69.4%) patients were found to have pathological evidence of cholestasis consistent with bile obstruction. Patients that were found to have evidence of obstruction had significantly increased odds that fibrosis stage 2 would be found on pathological diagnosis (OR 6.75, 95% CI 1.20\u201338.02, Fisher\u2019s exact test <jats:italic>P<\/jats:italic> value = 0.0312). There was no significant association in patients who were stented compared to non\u2010stented patients and their diagnosis of high\u2010grade fibrosis stage 2 (OR 1.5238, 95% CI 0.4019\u20135.7769, Fisher\u2019s exact test <jats:italic>P<\/jats:italic> value = 0.7360).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>An astonishing 63.9% of patients who underwent PD were diagnosed with stage 1\u20134 liver fibrosis and half (47.2%) had fibrosis stage of 2 or more. Further, stent status had no significant impact on the degree of liver fibrosis. Liver fibrosis is currently underrecognized in patients undergoing PD, which is important for physicians to be conscious of as it is known that liver fibrosis increases morbidity and mortality.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-017-4101-9","type":"journal-article","created":{"date-parts":[[2017,7,17]],"date-time":"2017-07-17T18:52:17Z","timestamp":1500317537000},"page":"2854-2857","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Undiagnosed Liver Fibrosis in Patients Undergoing Pancreatoduodenectomy for Pancreatic Adenocarcinoma"],"prefix":"10.1002","volume":"41","author":[{"given":"Andrew","family":"Gdowski","sequence":"first","affiliation":[{"name":"Department of Molecular and Medical Genetics University of North Texas Health Science Center Dallas TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Houssam","family":"Osman","sequence":"additional","affiliation":[{"name":"Department of Hepatopancreaticobiliary Surgery Dallas Methodist Medical Center Dallas TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Umar","family":"Butt","sequence":"additional","affiliation":[{"name":"Department of Hepatopancreaticobiliary Surgery Dallas Methodist Medical Center Dallas TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steve","family":"Foster","sequence":"additional","affiliation":[{"name":"Department of Pathology Dallas Methodist Medical Center Dallas TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dhiresh Rohan","family":"Jeyarajah","sequence":"additional","affiliation":[{"name":"Department of Hepatopancreaticobiliary Surgery Dallas Methodist Medical Center Dallas TX USA"},{"name":"221 West Coloradao Blvd, Pavillion 2, Suite 933 75208 Dallas TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2017,7,17]]},"reference":[{"key":"e_1_2_7_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/0168\u20108278(91)90006\u2010W"},{"issue":"3","key":"e_1_2_7_3_2","first-page":"305","article-title":"Prolonged bile duct obstruction: a new experimental model for cirrhosis in the rat","volume":"65","author":"Kountouras J","year":"1984","journal-title":"Br J Exp Pathol"},{"issue":"8304","key":"e_1_2_7_4_2","first-page":"896","article-title":"Preoperative external biliary drainage in obstructive jaundice","volume":"2","author":"Hatfield AR","year":"1982","journal-title":"A Prospect Control clin Trial Lancet"},{"key":"e_1_2_7_5_2","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.1800710522"},{"key":"e_1_2_7_6_2","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.1979.01370330086016"},{"key":"e_1_2_7_7_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200102083440604"},{"key":"e_1_2_7_8_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440\u20101746.2007.04901.x"},{"key":"e_1_2_7_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijsu.2010.10.008"},{"key":"e_1_2_7_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1091\u2010255X(00)80074\u20108"},{"key":"e_1_2_7_11_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1472\u20108206.2011.01020.x"},{"key":"e_1_2_7_12_2","first-page":"313","article-title":"Melatonin ameliorates liver fibrosis induced by bile\u2010duct ligation in rats","volume":"5","author":"Tahan G","year":"2010","journal-title":"Can J Surg"}],"container-title":["World Journal of Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/article\/10.1007\/s00268-017-4101-9\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1007\/s00268-017-4101-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1007\/s00268-017-4101-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1007\/s00268-017-4101-9","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,10]],"date-time":"2024-01-10T17:17:52Z","timestamp":1704907072000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1007\/s00268-017-4101-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,7,17]]},"references-count":11,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2017,11]]}},"alternative-id":["10.1007\/s00268-017-4101-9"],"URL":"https:\/\/doi.org\/10.1007\/s00268-017-4101-9","archive":["Portico"],"relation":{},"ISSN":["0364-2313","1432-2323"],"issn-type":[{"type":"print","value":"0364-2313"},{"type":"electronic","value":"1432-2323"}],"subject":[],"published":{"date-parts":[[2017,7,17]]}}}