[Indications for and operative outcome of hepato-pancreatoduodenectomy in the treatment of carcinoma of the gallbladder].
The indications for hepatopancreatoduodenectomy (HPD) are still controversial. Opinion is divided especially concerning the need to perform pancreatoduodenectomy (PD) for lymph node dissection, with some investigators claiming that the peripancreatic lymph nodes can be dissected adequately without PD. Detailed studies of resected specimens in our department have shown that preservation of the head of the pancreas carries an increased risk of leaving behind cancer cells in small lymph nodes and ducts remaining in the peripancreatic region. We therefore perform HPD in all patients at increased risk for metastasis to peripancreatic lymph nodes, as indicated by subserosal invasion with distinct evidence of lymph node involvement, tumor location at the neck or both fundus and body of the gallbladder, and serosa exposure to tumor irrespective of tumor location and lymph node involvement. When the outcome was compared between HPD and hepatic resection plus dissection of peripancreatic lymph nodes (HR), we found that the operative results of HPD were poor with extended lobectomy plus PD because of high rates of postoperative complications and operative mortality. However, the results have gradually improved with the introduction of percutaneous transehepatic portal embolization and advances in perioperative care. Although overall there is no difference between HPD and HR in long-term outcome, the outcome with HPD is significantly better in node-positive patients and patients without hepatoduodenal ligament involvement, there by demonstrating the value of performing peripancreatic lymph node dissection by PD. However, there is no difference between HPD and HR in patients with hepatoduodenal ligament involvement, and attempts to develop other new and effective means of treatment should continue.
Yoshikawa
T
T
Department of Surgery, Tokyo Metropolitan Ebara Hospital, Japan.
Ohta
T
T
Araida
T
T
Azuma
T
T
Takasaki
K
K
D005706:Gallbladder Neoplasms / Q000601:surgery*; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000517:prevention & control; D016577:Pancreaticoduodenectomy; D016896:Treatment Outcome