Hepatopancretoduodenectomy for gallbladder cancer with duodenal infiltration. Report of 1 case

Abstract

Presenter: Fabio Vergara MD | IPS Universitaria - Servicios de Salud de la Universidad de Antioquia Background: Gallbladder cancer is the most common cancer of the biliary tract . Surgical resection is the election treatment for curative intention. Hepatopancreatoduodenectomy is a technique for remove the advanced gallbladder cáncer with infiltrated parts within the liver, lower biliary tract and the peripancreatic region. However, in this technique were reported to have a higher postoperative morbidity (70 - 80%) and mortality around 30%. Methods: We presented a case of gallbladder cancer with duodenal and distal biliary tract infiltration. A 68 years old woman admitted for jaundice and weight loss. Abdominal ultrasound with evidence of cholelithiasis and bile duct dilatation. MRI was performed and a gallbladder tumor was found with infiltration of the bile duct in contact with the duodenum. Tumorals markers with ca 19.9: 350U/L. Extension studies without metastases. It was decided to take surgery for oncological resection. Duodenal infiltration was found intraoperatively, so it was decided to perform hepatopancreatoduodenectomy that includes hepatectomy segments IVB and V, pancreatoduodenectomy and lymphadenectomy. Results: The intraoperative evolution occurred without the need for vasopressor support or blood transfusion. The surgical time was 240 minutes. The patient was extubated and taken to the ICU for surveillance. He presented a type B pancreatic fistula, which required medical management with analogues of somatostatin, parenteral nutrition and antibiotherapy. Discharged after 15 days. Pathology confirms a gallbladder cancer with nodal metastases an duodenal infiltration. Conclusion: Hepatopancreatoduodenectomy is a complex surgery. It is a surgery that contains both hepatic and pancreatic resection surgical techniques. Is beneficial for selected patients to achieved R0 resection in advanced gallbladder cancer. However, the indications should be carefully evaluated because of greater morbidity rates. This surgery is recommended to be done in centers with experience in hepatopancreatobiliary surgery.