title: Central hepatectomy with pancreatoduodenectomy for diffusely spread bile duct cancer.
abstract: BACKGROUND
  Major hepatectomy with concomitant pancreatoduodenectomy (major-HPD) is the only procedure that provides a curative resection for diffusely spread extrahepatic bile duct cancer (DSEBDC). We sometimes encounter patients who cannot undergo major-HPD because of a poor functional hepatic reserve. The aim of the present study was to assess the feasibility of central hepatectomy with pancreatoduodenectomy (central-HPD) for patients with DSEBDC as an alternative to major-HPD.
  
  
  METHODS
  Between 2002 and 2010, six patients with DSEBDC underwent central-HPD. The hepatectomy procedures for central-HPD included central bisectionectomy with S1 resection (S1r) and right anterior sectionectomy with S1r.
  
  
  RESULTS
  The estimated resection liver volume was decreased from 77.5% to 46.6% by the application of central-HPD. The median operative duration was 929 min, and the median blood loss was 2568 ml. Postoperative complications were observed in five patients. The proximal ductal stump was histologically positive with non-invasive cancer in three patients and positive with invasive cancer in one. The overall survival of the six patients was 62.5% at 5 years after surgery.
  
  
  CONCLUSIONS
  While central-HPD was a technically complicated procedure associated with a high morbidity rate, it offered a favorable overall survival and might be an alternative option for DSEBDC patients with a poor hepatic functional reserve.
authors.affiliation: Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan. takashimzn@gmail.com.
authors.forename: Takashi
authors.initials: T
authors.lastname: Mizuno
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Kanemoto
authors.forename: Teiichi
authors.initials: T
authors.lastname: Sugiura
authors.forename: Yukiyasu
authors.initials: Y
authors.lastname: Okamura
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Uesaka
mesh_terms: D000368:Aged; D001650:Bile Duct Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008297:Male; D009361:Neoplasm Invasiveness; D016577:Pancreaticoduodenectomy / Q000379:methods*; D011183:Postoperative Complications; D012189:Retrospective Studies
keywords: Bile duct cancer; Central bisectionectomy; Pancreatoduodenectomy