Extended surgery in bilio-pancreatic cancer: the Japanese experience

Aggressive surgery has been used in bilio-pancreatic cancers in many institutions in Japan. Approaches in pancreatic cancer include extended lymph node and soft tissue dissection in patients with ductal carcinoma of the pancreatic head. In biliary tract disease, approaches have included hepatectomies with or without vascular resection, reconstruction designed according to the extent of disease in individual patients, and combined liver and pancreas resection (hepatopancreatoduodenectomy) in locally advanced disease. Based on current experience, portal vein resection can be recommended in both pancreatic cancer and hilar cholangiocarcinoma and in select patients with gallbladder disease. Extended dissection of para-aortic lymph nodes is recommended in hilar cholangiocarcinoma but not in gallbladder disease; extended lymph node dissection in pancreatic cancer currently is being evaluated in a randomized controlled trial. Hepatopancreatoduodenectomy is recommended for select patients with gallbladder cancer.