Abstract
Introduction: Hepatopancreatoduodenectomy with extensive hepatic resection (M-HPD) remains a difficult and complex surgery. We sought to evaluate our procedures of M-HPD in patients with biliary diseases. Method: We reviewed data from 52 patients who underwent M-HPD between 2001 to 2017. The postoperative course and overall survival (OS) were investigated.The indocyanine green clearance test value (ICG15 min), and the size of future remnant liver volume (FRLV) were used to determine patient tolerance for undergoing each type of hepatectomy. Portal vein embolization (PE) was performed in cases of right hepatectomy or bilateral trisectionectomy 2 or 3 weeks before HPD. Results: The numbers of patients who underwent right hepatectomy, left hepatectomy, left trisectionectomy, and right trisectionectomy were 36, 12, 2, and 2, respectively. Forty-five patients had bile duct cancer and 6 had gallbladder cancer. One patient was diagnosed with cholangitis based on pathological investigation. Median [range] values for operative time and blood loss were 722 [552–989] min and 1855 [840-6180] ml, respectively. PTPE was performed in 41 (79%) patients. Postoperative complications with Clavien-Dindo (CD) grade IIIa or higher developed in 33 (63%) patients. The mean operative time in patients with CD grade IIIa or higher was significantly longer than that in patients with CD grade II or lower (p = 0.0103). Median survival time, and 3- and 5-year OS for the entire cohort were 33 months, 48%, and 25%, respectively. Conclusions: Candidates for M-HPD should be selected strictly based on future remnant hepatic function. Complicated procedures requiring prolonged operative time should be avoided.
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call