Hepatopancreatoduodenectomy for advanced biliary malignancies
10.1097/CM9.0000000000002067
- VernacularTitle:Hepatopancreatoduodenectomy for advanced biliary malignancies
- Author:
Xiangsong WU
1
;
Maolan LI
;
Wenguang WU
;
Xu’an WANG
;
Huaifeng LI
;
Runfa BAO
;
Yijun SHU
;
Jun SHEN
;
Jun GU
;
Xuefeng WANG
;
Wei GONG
;
Shuyou PENG
;
Yingbin LIU
Author Information
1. Department of General Surgery, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
- Keywords:
Hepatectomy;
Hepatopancreatoduodenectomy;
Gallbladder cancer;
Cholangiocarcinoma
- From:
Chinese Medical Journal
2022;135(23):2851-2858
- CountryChina
- Language:Chinese
-
Abstract:
Background::Hepatopancreatoduodenectomy (HPD) has been considered the only curative treatment for metastatic cholangiocarcinoma and some locally advanced gallbladder cancers (GBCs). However, HPD has not yet been included in treatment guidelines as a standard surgical procedure in consideration of its morbidity and mortality rates. The aim of this study was to evaluate the safety and effectiveness of HPD in treating biliary malignancies.Methods::The medical records of 57 patients with advanced biliary cancer undergoing HPD from January 2009 to December 2019 were retrospectively retrieved. A case-control analysis was conducted at our department. Patients with advanced GBC who underwent HPD (HPD-GBC group) were compared with a control group (None-HPD-GBC group). Baseline characteristics, preoperative treatments, tumor pathologic features, operative results, and prognosis were assessed.Results::Thirteen patients with cholangiocarcinoma and 44 patients with GBC underwent HPD at our department. Significant postoperative complications (grade III or greater) and postoperative pancreatic fistula were observed in 24 (42.1%) and 15 (26.3%) patients, respectively. One postoperative death occurred in the present study. Overall survival (OS) was longer in patients with advanced cholangiocarcinoma than in those with GBC (median survival time [MST], 31 months vs. 11 months; P < 0.001). In the subgroup analysis of patients with advanced GBC, multivariate analysis demonstrated that T4 stage tumors ( P = 0.012), N2 tumors ( P = 0.001), and positive margin status ( P = 0.004) were independently associated with poorer OS. Patients with either one or more prognostic factors exhibited a shorter MST than patients without those prognostic factors ( P < 0.001). Conclusion::HPD could be performed with a relatively low mortality rate and an acceptable morbidity rate in an experienced high-volume center. For patients with advanced GBC without an N2 or T4 tumor, HPD can be a preferable treatment option.
