Indication of Hepatopancreatoduodenectomy for Biliary Tract Cancer

Abstract

The indication for a hepatopancreatoduodenectomy (HPD) in patients with advanced biliary tract cancer is still controversial, because this aggressive surgery might be associated with high mortality and morbidity rates. In this study, we review our experience with HPD for advanced biliary tract cancer, and seek to define the indication for HPD. Eleven patients with biliary tract cancer underwent HPD at Wakayama Medical University Hospital between 1986 and 2004. Univariate analysis was used to assess independent variables of the mortality and morbidity associated with HPD. The rates of mortality and morbidity were 18% and 82%, respectively. Univariate analysis showed that the total serum bilirubin level before surgery and the hepatic parenchymal resection of more than two Healey's segments correlated significantly with an increased risk of severe complications (P = 0.044, 0.0152, respectively). The 1-, 2-, and 3-year survival rates were 44%, 33%, and 11%, respectively. Hepatopancreatoduodenectomy might offer a chance of long survival by yielding a tumor-free margin in selected patients who are able to tolerate such an aggressive operation, but the indication for this aggressive surgery should be carefully considered.