POSTOPERATIVE COURSE AND HEPATIC REGENERATION AFTER HEPATOPANCREATODUODENECTOMY FOR BILIARY TRACT CARCINOMA

Abstract

Hepatopancreatoduodenectomy (HPD) with hepatectomy has been widely employed for advanced biliary tract carcinomas. In this paper 10 patients with biliary tract carcinoma undergoing HPD with hepatectomy were compared with control groups for operative stress, hepatic regeneration, and postoperative complications. These 10 patients were divided into 2 groups, namely 6 undergoing resection of more than 2 segments and 4, less than 2 segments. Another each 10 patients undergoing extended hepatectomy or HPD were severed as control. HPD patients with hepatectomy of more than 2 segments showed significantly greater values in operative bleeding amount, operating time, and postoperative complications than those of other 3 groups. Postoperative total serum bilirubin significantly increased in HPD with hepatectomy (more than 2 segments) group. There were no differences in restoration of remnant hepatic volume after extended hepatic lobectomy with or without pancreatoduodenectomy. Median survival after HPD was 12 months. According to a questionnaire survey reported at the 16th Japan Pancreatectomy Society, the commonest cause of hospital deaths in HPD patients was hepatic failure, followed by preoperative T. Bil. level of 3mg/dl or more, age of over 60, hepatectomy of more than 2 segments, and association of vascular reconstruction, in this order (with significant difference). It is thought that an increase in total bilirubin well expresses a significantly severe operative stress with HPD than that with usual hepatectomy. Accordingly, HPD can escape associating with postoperative hepatic failure and other complications by an appropriate selection of operative candidates preceded by sufficient reduction of serum bilirubin; careful vascular reconstruction; and good nutritional management.