Safety and Oncological Benefit of Hepatopancreatoduodenectomy for Advanced Extrahepatic Cholangiocarcinoma with Horizont
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ORIGINAL ARTICLE – HEPATOBILIARY TUMORS
Safety and Oncological Benefit of Hepatopancreatoduodenectomy for Advanced Extrahepatic Cholangiocarcinoma with Horizontal Tumor Spread: Shinshu University Experience Akira Shimizu, MD, PhD , Hiroaki Motoyama, MD, PhD, Koji Kubota, MD, PhD, Tsuyoshi Notake, MD, PhD, Kentaro Fukushima, MD, Tomohiko Ikehara, MD, Hikaru Hayashi, MD, Koya Yasukawa, MD, Akira Kobayashi, 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
ABSTRACT Background. Although hepatopancreatoduodenectomy (HPD) is the only means of achieving R0 resection of widespread extrahepatic cholangiocarcinoma, its safety and oncological benefit remain controversial because of its inherent high risk of mortality and morbidity. Objective. The aim of this study was to retrospectively analyze short- and long-term outcomes and evaluate the safety and oncological benefit of this advanced procedure. Methods. The study cohort comprised 37 consecutive patients who had undergone major HPD. Portal vein embolization was performed before surgery in 20 (54%) patients with future remnant liver volume \ 35%. Results. The median operative time and blood loss were 866 min and 1000 mL, respectively. Concomitant vascular resection was performed in five patients (14%). The overall morbidity and mortality rates were 100% and 5.4% (n = 2), respectively. Nineteen patients (51%) had major (Clavien– Dindo grade III or higher) complications, the most common being intra-abdominal infection (49%) and posthepatectomy liver failure (46%, grade B/C: 32%/5%), followed by postoperative pancreatic fistula (30%, grade B/C). R0 resection was achieved in 31 patients (84%). The 1-, 3-, and 5-year overall survival (OS) rates were 83%, 48%, and 37%, respectively. In patients with R0 resection,
Ó Society of Surgical Oncology 2020 First Received: 4 April 2020 Accepted: 19 September 2020 A. Shimizu, MD, PhD e-mail: [email protected]
5-year OS was comparable between patients who had undergone major HPD and major hepatectomy alone (41% vs. 40%, p = non-significant). Conclusions. HPD is a valid treatment option for extensive cholangiocarcinoma, offering long-term survival benefit at the cost of relatively high but acceptable morbidity and mortality rates. HPD is advocated in selected patients provided that it is considered possible to achieve R0 resection.
Surgical resection is considered the only definitive treatment for biliary tract malignancies.1–3 Major hepatopancreatoduodenectomy (HPD) offers the greatest possibility of achieving negative ductal margins (DMs) for cholangiocarcinoma with extensive horizontal ductal spread. Since Takasaki et al.4 first introduced HPD as a means of treating advanced hepatobiliary malignancies, many Japanese surgeons and several Western surgeons have attempted this challenging procedure.5–13 However, because of the limited number of patients in a single cente
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