Outcomes and Prognostic Factors in Hepatopancreatoduodenectomy

Hepatopancreatoduodenectomy (HPD) is a potentially curative option for selected patients with advanced cholangiocarcinoma or gallbladder cancer, but it is associated with substantial morbidity. In this study, we evaluated short- and long-term outcomes after HPD and identified prognostic factors.

Patients who underwent HPD at the Seoul National University Hospital, South Korea from 2000 to 2023 were included. Prospectively collected data on patient and tumor characteristics, perioperative and survival outcomes were analyzed. Prognostic factors were assessed using Cox proportional hazards models, and risk factors for disease-free survival (DFS) <12 months were explored using logistic regression.

The 30-day mortality rate was 0%, the 90-day mortality rate was 6%, and major complications (Clavien-Dindo grade ≥III) occurred in 58% of patients. The median overall survival (OS) was 21 months, and median DFS was 12 months. The 5-year survival rate was 16%. In multivariable analysis, angiolymphatic invasion was an independent prognostic factor for both OS and DFS. Adjuvant treatment was associated with an improved OS. For DFS <12 months, preoperative carbohydrate antigen (CA) 19-9 level and angiolymphatic invasion were independent risk factors.

Despite high morbidity, HPD can provide meaningful long-term survival in carefully selected patients. Preoperative CA 19-9 and angiolymphatic invasion may aid risk stratification. Associations between adjuvant treatment and survival outcomes should be interpreted cautiously and warrant confirmation in larger, prospective multicenter studies.