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Colorectal Surgery in Patients with Liver Cirrhosis: A Systematic Review

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Abstract

Background

Colorectal surgery in patients with liver cirrhosis poses a significant challenge due to the associated peri-operative morbidity and mortality risks. The aim of this systematic review was to evaluate the outcomes in this cohort of patients following colorectal surgery.

Methods

The PubMed, Embase and Cochrane databases and references were searched up to October 2022 using the PRISMA guidelines. The data collated included: patient demographics, pathology or type of colorectal operation performed, severity of liver cirrhosis, post-operative complication rates, mortality rates and prognostic factors. A quality assessment of included studies was performed with the Newcastle–Ottawa scale.

Results

Sixteen studies reporting the outcomes of colorectal surgery in patients with liver cirrhosis were identified, including the results of 8646 patients. The indications, pathologies and/or type of operations varied. The overall complication rate ranged from 29 to 75%, minor complication ranged 14.5–37% and major complication ranged 6.7–59.3%. The mortality rates ranged from 0 to 37%.

Conclusion

Colorectal surgery in patients with liver cirrhosis still carries considerable morbidity and mortality rates. This group of patients needs to be managed in a multidisciplinary setting to achieve excellent outcomes. Future research should focus on uniform definitions to enable interpretable outcomes.

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Acknowledgements

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Authors and Affiliations

  1. Department of General Surgery, Royal Perth Hospital, Wellington Street, Perth, WA, 6000, Australia

    Zi Qin Ng, Patrick Tan & Mary Theophilus

  2. Department of General Surgery, St John of God Midland Hospital, Midland, WA, Australia

    Zi Qin Ng & Mary Theophilus

  3. Curtin Medical School, Curtin University, Bentley, WA, Australia

    Mary Theophilus

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Contributions

ZQN designed the study, collected and analysed the data, and drafted the manuscript. PT analyzed the data and critically reviewed the manuscript. MT co-designed the study, collected and analysed the data, and reviewed the manuscript. All authors approved the final version of the manuscript to be submitted for review and publication.

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Correspondence to Zi Qin Ng.

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Ng, Z.Q., Tan, P. & Theophilus, M. Colorectal Surgery in Patients with Liver Cirrhosis: A Systematic Review. World J Surg 47, 2519–2531 (2023). https://doi.org/10.1007/s00268-023-07069-3

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