title: Operative and perioperative management experience for hepatobiliary malignancies following ERCP-related pancreatitis.
abstract: OBJECTIVE
  There have been few papers on how to treat hepatobiliary malignancies after ERCP-related pancreatitis focusing on the timing of the operation and postoperative complications. The aim of this study was to clarify the relationship among the time after the pancreatitis, the complexity of the operation, and the characteristic postoperative complications.
  
  
  METHODS
  The clinicopathological characteristics of five patients with hepatobiliary malignancies who had a prior history of ERCP-related pancreatitis were analyzed.
  
  
  RESULTS
  The five patients included two with extrahepatic bile duct carcinomas, two with ampulla of Vater carcinomas, and one with intrahepatic hilar cholangiocarcinoma. The median time to the operation from pancreatitis was 31 (16-116) days. The median operation time and blood loss were 661 (576-924) min and 3695 (2730-7240) mL, respectively. Various postoperative complications were seen in all cases including acute respiratory distress syndrome and infection of peripancreatic necrosis. The postoperative mortality rate was 0%, with a morbidity rate of 100%. R0 operations were performed in all five cases.
  
  
  CONCLUSIONS
  Surgery for hepatobiliary malignancies after ERCP-related pancreatitis appears to have a high morbidity rate. The surgery must strike a balance between curability of the malignancy and safety with respect to the frequent postoperative complications.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Tsuchikawa
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hirano
authors.forename: Eiichi
authors.initials: E
authors.lastname: Tanaka
authors.forename: Kentaro
authors.initials: K
authors.lastname: Kato
authors.forename: Joe
authors.initials: J
authors.lastname: Matsumoto
authors.forename: Takehiro
authors.initials: T
authors.lastname: Noji
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Shichinohe
mesh_terms: D000368:Aged; D014670:Ampulla of Vater; D001650:Bile Duct Neoplasms / Q000601:surgery*; D017734:Bile Ducts, Extrahepatic; D018281:Cholangiocarcinoma / Q000601:surgery; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D003138:Common Bile Duct Neoplasms / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000150:complications*; D011183:Postoperative Complications / Q000453:epidemiology