Elsevier

Surgery

Volume 153, Issue 6, June 2013, Pages 794-800
Surgery

Original Communication
Is extended hemihepatectomy plus pancreaticoduodenectomy justified for advanced bile duct cancer and gallbladder cancer?

https://doi.org/10.1016/j.surg.2012.11.024Get rights and content

Background

Major hepatopancreaticoduodenectomy (HPD) is an extensive surgical procedure offering the highest curability for patients with advanced biliary cancer. However, surgical morbidity associated with major HPD is high, and optimal indications for this procedure remain unclear.

Methods

Between 1989 and 2010, 14 patients with widespread bile duct cancer and 5 with gallbladder cancer having biliary infiltration underwent major HPD at our hospital. Preoperative portal vein embolization was performed in 17 patients undergoing right HPD. Clinicopathologic factors and survivals following HPD were compared between patients with bile duct cancer and those with gallbladder cancer.

Results

One patient who underwent right HPD for gallbladder cancer died of hepatic failure (5.3%) and 18 of the 19 patients (95%) developed postoperative pancreatic fistulas. The median hospital stay was 47 days. Depth of invasion was T3 in 1 patient and T4 in 2 patients with bile duct cancer and was T4 in all 5 patients with gallbladder cancer (P = .002). The clinical stage was IV in 3 patients (21%) with bile duct cancer and in all 5 patients with gallbladder cancer (P = .002). The 5-year survival rates and median survival rates of patients with bile duct cancer and gallbladder cancer were 45% vs 0 and 3.3 years vs 8 months, respectively (P < .001).

Conclusion

HPD can be an acceptable treatment option for widespread bile duct cancer. However, the indication for HPD in advanced-stage gallbladder cancer should be considered carefully, considering the high morbidity rate and the advanced stage of the disease.

Section snippets

Methods

Between 1989 and 2010, 283 patients with bile duct cancer (excluding intrahepatic cholangiocarcinoma) and 204 patients with gallbladder cancer underwent surgical resection at the Hepatobiliary and Pancreatic Surgery Division, National Cancer Hospital, Tokyo. Of these, 14 patients with widespread bile duct cancer (4.9%) underwent right or left HPD, and 5 patients with gallbladder cancer having biliary infiltration (2.5%) underwent right HPD. One patient underwent right HPD on the preoperative

Surgical outcomes

Right HPD was performed in 17 patients, and left HPD was performed in 2 patients. Of these, HPD was scheduled at the beginning of surgery in 12 patients (7 with bile duct cancer and 5 with gallbladder cancer), according to imaging or intraoperative findings, including palpation of the hepatoduodenal ligament in 4 patients with bile duct cancer. In the remaining 3 patients, HPD proceeded based on the findings in the ductal margins; in 2 patients, extended right hemihepatectomy was performed when

Discussion

The present results showed a remarkable contrast with regard to the prognoses of patients undergoing HPD for bile duct cancer and gallbladder cancer. In 14 patients with bile duct cancer, 11 (79%) had T1 or T2 tumors, and the final stage was I or II in 11 other patients. The radial margin was negative in 93% of these patients, and the overall 5-year survival rate was 45%. In contrast, in 5 patients with gallbladder cancer, all had T4 tumors, and the final stage was IV in all. Biliary

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    Supported in part by a grant-in-aid for scientific research from the Ministry of Health and Welfare of Japan and the National Cancer Center Research and Development Fund.

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