Safety and prognosis of pancreaticoduodenectomy in HBsAg-positive patients based on propensity score matching analysis: a retrospective study

Abstract

Due to the lack of reliable evidence regarding pancreaticoduodenectomy (PD) in patients with hepatitis B virus (HBV) infection, it is necessary to clarify the impact of HBV on patients subjected to PD. A total of 201 patients were enrolled and divided into two groups according to the presence or absence of preoperative hepatitis B surface antigen (HBsAg) positivity. Based on the patient's clinical data, and laboratory indicators, propensity score matching and subgroup analysis were performed to assess the safety of PD in individuals with HBsAg-positive status. Ultimately, 52 patients were included in the aforementioned analysis. Compared with HBsAg-negative patients, HBsAg-positive patients exhibited lower preoperative serum albumin levels (38.04 ± 4.44 g/L vs 40.88 ± 5.40 g/L, P =0.043) and lower Alb levels on postoperative day 5 (33.01 ± 3.69 g/L vs 35.38 ± 4.70 g/L, P =0.049). Intraoperative blood loss was higher in HBsAg-positive patients [375.00 (262.50, 500.00) mL vs 300.00 (200.00, 300.00) mL, P =0.012]. No significant difference in long-term survival was observed between the two groups. Patients with higher HBsAg titers had increased intraoperative blood loss [450.00 (312.50, 500.00) mL vs 300.00 (200.00, 400.00) mL, P =0.045], higher incidences of postoperative pancreatic fistula (POPF) (71.43% vs 21.43%, P =0.021) and intra-abdominal infection (78.57% vs 21.73%, P =0.007), as well as higher hospitalization costs [90907.71 (80,824.23, 99,259.95) CNY vs 71,869.95 (67,613.81, 73,974.12) CNY, P <0.001], and worse prognosis ( P =0.046). Patients with higher preoperative total bilirubin levels had higher incidences of postoperative complications (90.00% vs 44.44%, P =0.041), POPF (80.00% vs 27.78%, P =0.016), and intra-abdominal infection (90.00% vs 27.78%, P =0.004), along with poorer prognosis ( P =0.013). PD is feasible in HBsAg-positive patients. Preoperative detection of HBsAg titer or HBV-DNA load, close monitoring of liver function, and active management of complications are beneficial for perioperative management. Nevertheless, large-scale, multicenter clinical trials are still required to further validate the findings of this study.