The risk of surgery in patients with cirrhosis

Several reasons result in the finding that patients with cirrhosis need surgery more often than other patients groups. Patients with cirrhosis frequently have comorbidities resulting in gastrointesti- nal, lung or cervical cancer, among others. Independent of cirrho- sis, surgical resection may be the best alternative for a number of those malignancies. Comorbidities may also result in an increased incidence of vascular complications (such as lower extremity ath- erosclerosis and coronary stenosis) some of them being potential indications for surgery. Patients with alcoholic cirrhosis are more frequently subjected to trauma and bone fractures. Ascites leads to umbilical hernia which can be strangulated or ruptured. Emergency surgery may be needed in this context. Finally, a sig- nificant proportion of patients with cirrhosis develop hepatocellu- lar carcinoma (HCC) during the course of the disease. Surgical resection remains a first line option for HCC. While reliable guide- lines have been proposed for surgical resection of HCC and liver transplantation, no precise guidelines are available for other aspects of surgical management during cirrhosis. Specific surgical procedures such as hepatectomy and transplantation are concen- trated in highly specialised centres, where detailed evaluation is relatively easy to obtain. In contrast, more general surgical proce- dures, either abdominal or non abdominal, are performed in var- ious centres, making it more difficult to obtain detailed evaluation and draw recommendations. General surveys are still needed to precisely assess the risk of non-specific surgery in patients with cirrhosis, to identify risk factors and to propose reliable guide- lines. (Acta gastroenterol. belg., 2008, 71, 42-46).