Major hepatectomy with simultaneous pancreatectomy for advanced hepatobiliary cancer

Combined major hepatectomy with pancreatectomy (MHP) is a rarely used operation for the treatment of hepatobiliary cancer. Few reports have discussed the utility of this procedure and its indications are poorly defined. The aim of this study was to review our experience with MHP.

A review of our prospective hepatobiliary surgical database between January 1994 and July 2000 identified 17 patients who had undergone MHP. Preoperative radiographic and laboratory data, intraoperative findings, hospital outcomes, and longterm followup were obtained.

A total of 3,579 patients with hepatobiliary malignancy were seen at our institution, of which 1,280 underwent resection and 17 (1.3%) had an MHP. The median age was 58 years (range 24 to 76). Histology was as follows: eight neuroendocrine carcinoma, three sarcoma, two cholangiocarcinoma, one ampullary carcinoma, one gallbladder carcinoma, one gastric carcinoma recurrence, and one benign fibrosis. All 17 patients underwent resection of two or more hepatic segments. Nine patients underwent a distal pancreatectomy and eight underwent a pancreaticoduodenectomy. Median operative time was 6 hours (range 4 to 8) and the median blood loss was 900 mL (range 150 to 2,500). Postoperative complications occurred in eight patients (47%), and there were three perioperative deaths (18%). All three deaths occurred in patients who underwent a pancreaticoduodenectomy combined with a hemi-hepactomy or greater. Eight patients are free of disease with a median followup of 54 months. Six patients have recurred, two of whom have died of disease with a median disease-free interval of 8 months.

MHP is associated with a high morbidity and mortality and should only be considered in highly selected patients when a significant potential oncologic benefit is possible.