An experience of hepatopancreatoduodenectomy in patients with hepatobiliary malignancies.
OBJECTIVE
In the advanced stage of hepatobiliary malignancies, concurrent hepatopancreatoduodenectomy (HPD) is necessary to accomplish curative resection, even though high rates of morbidity and mortality still remain.


METHODS
We examined the surgical records and outcome in 11 patients undergoing HPD.


RESULTS
In 11 patients, diseases included bile duct carcinomas in 7 patients, gallbladder carcinomas in 3, and ampullar carcinoma in one. Hemi-hepatectomy with resection of the caudate lobe was performed in 8 patients and resection of segment 4 and 5 of the liver in two. Pancreatoduodenectomy (PD) was performed in 3 patients and pylorus-preserving PD in 8. Curative resection was accomplished in 8 patients. Two patients underwent adjuvant photodynamic therapy because of a cancer-positive margin. Morbidity rate was 36% but no hospital deaths were reported. The tumor recurrence rate was 73% and 8 patients died of cancer. Patient prognosis of gallbladder cancers (12 +/- 1 months) tended to be shorter than in patients with bile duct cancers (19 +/- 11 months) (p=0.15). Three patients with bile duct cancers survived without tumor relapse over 12 months.


CONCLUSIONS
Complete surgical resection (R0) by HPD could be safely performed for diseases of the hepatobiliary malignancies, which achieved longer survival in some patients.
Nanashima
Atsushi
A
Division of Surgical Oncology, Department of Translational Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences 1-7-1 Sakamoto, Nagasaki 852-8501, Japan. a-nanasm@net.nagasaki-u.ac.jp
Nagasaki
Toshiya
T
Sumida
Yorihisa
Y
Abo
Takafumi
T
Tobinaga
Syuuichi
S
Takeshita
Hiroaki
H
Nonaka
Takashi
T
Hidaka
Shigekazu
S
Sawai
Terumitsu
T
Yasutake
Toru
T
Nagayasu
Takeshi
T
D000368:Aged; D001650:Bile Duct Neoplasms / Q000401:mortality / Q000601:surgery*; D005260:Female; D005706:Gallbladder Neoplasms / Q000401:mortality / Q000601:surgery*; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology