[Clinical evaluation of hepatopancreatoduodenectomy]

The clinical outcome of hepatopancreatoduodenectomy (HPD) carried out in 14 patients in our institute was evaluated retrospectively. In principle, HPD is performed in patients with far-advanced biliary carcinoma extending from the level of the liver to pancreas directly or via metastatic lymph nodes around the head of the pancreas. However, the survival periods after surgery did not improve, contrary to expectations. Curative surgery was not achieved in most patients who underwent HPD, even if resection of the portal vein or hepatoduodenal ligament was performed during surgery. Severe lymphatic, vascular, and neural involvement along the hepatoduodenal ligament existed in those patients. In addition, it is possible that they already had micrometastases to other organs based on a study of the pattern of recurrence after surgery. Quality of life did not appear to improve unless the patients survived more than one year. These findings suggest that HPD may be appropriate for patients in earlier disease stages than those in our series to achieve longer survival. However, HPD is associated with high rates of postoperative complications and operative mortality, especially after pancreatoduodenectomy with liver resection involving more than right hepatectomy. We need to establish the appropriate indications for HPD and improve the safety of the procedure.