ASO Author Reflections: Is Major Hepatopancreatoduodenectomy Beneficial for Patients with Advanced and Widespread Extrah
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ASO AUTHOR REFLECTIONS
ASO Author Reflections: Is Major Hepatopancreatoduodenectomy Beneficial for Patients with Advanced and Widespread Extrahepatic Cholangiocarcinoma? Akira Shimizu, MD, PhD
, and Yuji Soejima, MD, PhD
Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
PAST Major hepatopancreatoduodenectomy (HPD) is considered one of the few treatment options that can achieve negative resection margins for advanced or widespread extrahepatic cholangiocarcinoma. Despite reports on the short-term and long-term outcomes after major HPD from several countries (mainly Japan), the usefulness of major HPD is not universally accepted because of its high mortality and morbidity.1–3 PRESENT A total of 235 patients who underwent major hepatectomy for extrahepatic cholangiocarcinoma between 1990 and 2019 were enrolled in our study. The patients were divided into two groups: 37 patients who underwent major HPD and 198 patients who underwent major hepatectomy alone. The two groups were compared for their short-term and long-term outcomes. The mortality rate of major HPD was 5.4% (n = 2), with post-hepatectomy liver failure (PHLF) as the cause of death. Although the two groups had comparable overall survival rates, overall survival was significantly higher after major HPD with R0 resection than after major hepatectomy alone with positive distal ductal margin. Among the 37 patients who underwent
major HPD, multivariate analysis revealed that a future liver remnant plasma clearance rate of indocyanine green \ 0.075 was an independent risk factor for grade B/C PHLF, especially in patients aged C 70 years.4 R0 resection was a common feature in 10 patients who survived beyond 5 years after major HPD, consistent with findings in several previous studies.2,5,6 FUTURE The short-term and long-term outcomes of 37 patients who underwent major HPD were acceptable. Therefore, major HPD is considered a feasible and useful treatment option for selected patients with advanced or widespread cholangiocarcinoma, in whom R0 resection can be achieved. Liver transplantation is considered an alternative surgical treatment option for perihilar cholangiocarcinoma.7 However, it remains unclear which patients will benefit from major HPD or liver transplantation. Therefore, additional large-scale studies to clarify the operative indications for these procedures are warranted in the future.
FUNDING
No funding was received specifically for this study.
DISCLOSURES
Neither author has any conflicts of interest.
REFERENCES Ó Society of Surgical Oncology 2020 First Received: 5 October 2020 Accepted: 5 October 2020 A. Shimizu, MD, PhD e-mail: [email protected]
1. Nimura Y, Hayakawa N, Kamiya J, et al. Hepatopancreatoduodenectomy for advanced carcinoma of the biliary tract. Hepatogastroenterology. 1991;38(2):170-175. 2. Wakai T, Shirai Y, Tsuchiya Y, Nomura T, Akazawa K, Hatakeyama K. Combined major hepatectomy and
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