Hepatopancreatoduodenectomy for Biliary Cancer

Abstract

Hepatopancreatoduodenectomy (HPD), that is, en bloc hepatic resection with pancreatoduodenectomy (PD), has been used as a radical operation for advanced carcinoma of the biliary tract. From September 1979 to December 1994, HPD was performed on 37 patients with advanced biliary cancer. Several kinds of hepatic segmentectomies with caudate lobe resection were applied in 17 cases of bile duct cancer, and four types of liver resections with PD were carried out in 20 patients with gallbladder cancer. Combined HPD and portal vein resection were performed in 7 cases of bile duct cancer and 9 cases of gallbladder cancer. Postoperative morbidity was high, both in bile duct cancer patients (76%) and in gallbladder cancer patients (45%). The 30-day operative mortality rate for patients undergoing HPD was 14% and hospital mortality was 22%. However, no fatal complication has been encountered after employing preoperative portal vein embolization for 4 patients undergoing major hepatectomy with PD. The 1- and 2-year survival rates for 15 patients with bile duct cancer undergoing curative HPD were 30% and 20%, respectively, and 15 patients died within 3 years. The 1-, 3-, and 5-year survival rates for 18 patients undergoing curative PD and hepatectomy of more than 4a,5,6 segmentectomy for gallbladder cancer were 50%, 6%, and 6%, and those for 12 patients undergoing curative PD and extended right lobectomy were 50%, 8%, and 8%, respectively. It should be considered that HPD was associated not only with an unexpectedly long survival period but also with high morbidity and mortality.