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An experience of hepatopancreatoduodenectomy in patients with hepatobiliary malignancies
Atsushi Nanashima1, Toshiya Nagasaki, Yorihisa Sumida
1Division of Surgical Oncology, Department of Translational Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences 1-7-1 Sakamoto, Nagasaki 852-8501, Japan. a-nanasm@net.nagasaki-u.ac.jp
Insights
Hepatopancreatoduodenectomy (HPD) offers safe, curative resection for advanced hepatobiliary cancers. While morbidity exists, R0 resection is achievable, leading to longer survival for select patients with bile duct or gallbladder cancers.
Area of Science:
- Surgical Oncology
- Hepatobiliary Surgery
- Gastrointestinal Oncology
Background:
- Advanced hepatobiliary malignancies often require extensive surgery for curative intent.
- Concurrent hepatopancreatoduodenectomy (HPD) is a complex procedure with historically high morbidity and mortality rates.
Purpose of the Study:
- To evaluate the safety and outcomes of hepatopancreatoduodenectomy (HPD) in patients with advanced hepatobiliary malignancies.
- To assess the feasibility of achieving complete surgical resection (R0) and its impact on patient survival.
Main Methods:
- Retrospective analysis of surgical records and outcomes for 11 patients who underwent HPD.
- Detailed examination of surgical procedures, including hemi-hepatectomy, caudate lobe resection, and pancreatoduodenectomy variations.
Main Results:
- HPD was performed for bile duct (7), gallbladder (3), and ampullary (1) carcinomas.
- Curative resection (R0) was achieved in 8 patients; morbidity was 36% with no in-hospital deaths.
- Tumor recurrence occurred in 73% of patients, with a median survival of 19 months for bile duct cancers versus 12 months for gallbladder cancers.
Conclusions:
- Complete surgical resection (R0) via HPD is safely achievable for advanced hepatobiliary malignancies.
- HPD can lead to longer survival in select patient groups, particularly those with bile duct carcinomas.
- Adjuvant therapies like photodynamic therapy may be considered for positive margins post-HPD.
Background/Aims:
In the advanced stage of hepatobiliary malignancies, concurrent hepatopancreatoduodenectomy (HPD) is necessary to accomplish curative resection, even though high rates of morbidity and mortality still remain.
Methodology:
We examined the surgical records and outcome in 11 patients undergoing HPD.
Results:
In 11 patients, diseases included bile duct carcinomas in 7 patients, gallbladder carcinomas in 3, and ampullar carcinoma in one. Hemi-hepatectomy with resection of the caudate lobe was performed in 8 patients and resection of segment 4 and 5 of the liver in two. Pancreatoduodenectomy (PD) was performed in 3 patients and pylorus-preserving PD in 8. Curative resection was accomplished in 8 patients. Two patients underwent adjuvant photodynamic therapy because of a cancer-positive margin. Morbidity rate was 36% but no hospital deaths were reported. The tumor recurrence rate was 73% and 8 patients died of cancer. Patient prognosis of gallbladder cancers (12 +/- 1 months) tended to be shorter than in patients with bile duct cancers (19 +/- 11 months) (p=0.15). Three patients with bile duct cancers survived without tumor relapse over 12 months.
Conclusions:
Complete surgical resection (R0) by HPD could be safely performed for diseases of the hepatobiliary malignancies, which achieved longer survival in some patients.
