Right hepatopancreatoduodenectomy: improvements over 23 years to attain acceptability.
OBJECTIVE
Right hepatopancreatoduodenectomy (rt-HPD), a demanding procedure associated with high morbidity and mortality, remains the only curative option for some patients with biliary cancer. We retrospectively analyzed our progress over 23 years in making this operation safer.


METHODS
Fifty-eight patients who had undergone rt-HPD were enrolled. Gallbladder cancer was present in 33 patients and bile duct cancer in 25 patients. Comparisons of short-term results after surgery were made between the 1980s (16 patients), 1990s (28 patients), and 2000 to 2004 (14 patients).


RESULTS
Intraoperative blood loss decreased progressively and significantly. The incidence of pancreatic fistula, and leakage of pancreatojejunostomy and hepaticojejunostomy also decreased, as did the occurrence of liver failure. Infection varied little by decade, but some recent progress may be underway. Mortality decreased, although not significantly.


CONCLUSIONS
Refinements in techniques, imaging, and perioperative management have improved the outlook for patients requiring HPD for cure, but much more remains to be achieved. Our results are not satisfactory, but they may be acceptable, considering the lack of alternative curative treatment.
Ebata
Tomoki
T
Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan.
Nagino
Masato
M
Nishio
Hideki
H
Arai
Toshiyuki
T
Nimura
Yuji
Y
D000328:Adult; D000368:Aged; D001661:Biliary Tract Neoplasms / Q000601:surgery*; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome