[Post operative complications after hepatopancreatoduodenectomy (HPD)]

The postoperative complications, morbidity and mortality of hepatopancreatoduodenectomy (HPD) are reviewed based on reports by the Japanese Biliary Surgery Association, Japanese Pancreatectomy Association, and leading surgeons. Postoperative hepatic failure, the most important and lethal complication, is significantly correlated with patient age (older than 70 years), resected hapatic volume (hepatic bisegmentectomy or greater), combined resection of the portal vein, or temporal bypass of portal blood flow. In patients who undergo HPD with more than bisegmentectomy, the operative mortality rate is high rate, with reports of 39.7%, 23.0%, 12.5%, and 38.0%. To reduce the morbidity and mortality rates after HPD, it is important to avoid intraoperative hepatic ischemia and to maintain sufficient hepatic blood flow and high oxygen saturation of portal blood postoperatively using a respirator and inotropic agents.