title: An experience of hepatopancreatoduodenectomy in patients with hepatobiliary malignancies.
abstract: 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.
authors.affiliation: 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
authors.forename: Atsushi
authors.initials: A
authors.lastname: Nanashima
authors.forename: Toshiya
authors.initials: T
authors.lastname: Nagasaki
authors.forename: Yorihisa
authors.initials: Y
authors.lastname: Sumida
authors.forename: Takafumi
authors.initials: T
authors.lastname: Abo
authors.forename: Syuuichi
authors.initials: S
authors.lastname: Tobinaga
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Takeshita
authors.forename: Takashi
authors.initials: T
authors.lastname: Nonaka
authors.forename: Shigekazu
authors.initials: S
authors.lastname: Hidaka
authors.forename: Terumitsu
authors.initials: T
authors.lastname: Sawai
authors.forename: Toru
authors.initials: T
authors.lastname: Yasutake
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nagayasu
mesh_terms: 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