Hepaticopancreaticoduodenectomy for advanced gall bladder carcinoma: Is it worthwhile?

Abstract

Presenter: Vikas Gupta| PGIMER Chandigarh Background: Hepatico-pancreaticoduodenectomy(HPD) is curative option for locally advanced carcinoma gall bladder however its wide acceptance is debated due to concerns over high morbidity and mortality Methods: Twenty-four patients undergoing HPD for locally advanced carcinoma gall bladder were analyzed retrospectively. Patient and tumour characteristics, preoperative treatment and survival out comes were analyzed. Pancreatoduodenectomy component of HPD was done in standard fashion while hepatic component was tailored as per the extent of bile duct and liver involvement. Either bi-segmentectomy or modified right extended hepatectomy with segment 4apreserving was done Results: Median age was 54 years with male to female ratio 1:4. Twenty patients required preoperative biliary drainage and none required portal vein embolization . Mean future liver remnant was 41.2±4.67. Major hepatic resections were performed in 18 and bisegmentectomy was done in six. Vascular resection was performed in 10 (41.7%) patients when macroscopic vascular invasion was confirmed during surgery; combined resection/reconstruction of the portal vein and hepatic artery was carried out in 33.4% and 8.3% patients respectively. Direct invasion of the pancreas was observed in 19 (79%). R0 resection was achieved in 18 (75%). T3 disease was seen in 16 (66.7%) and T4 in 8 (33.3%). Node positivity was seen in 12 (50%). Grade B & C liver failure was seen in 2 and 3 patients respectively. Pancreatic fistula grade B was seen in 8 patients and grade C in none. Grade 3 or more complications were observed in 8 (33.33%)patients. Three (12.5%) patients died post operatively. Overall 1, 2 and 3 years survival rate was 72.7%, 45.5% and 9.1%, with a median survival time of 24 months. 1, 2 and 3 years survival rate was 90%, 60%, 10% respectively in node negative patients and 70%, 40%, 10% respectively in node positive disease.1, 2 and 3 years survival rate was 69.23%, 30.7%, 0% respectively without vascular resection and 77.77%, 66.66%, 22.22% respectively with vascular resection. Conclusion: HPD with vascular resection can be done safely in selected group of patients with advanced gall bladder cancer as it remains only option for long term cure.