title: Risk factors of morbidity and predictors of long-term survival after hepatopancreatoduodenectomy for biliary cancer.
abstract: OBJECTIVE
  Hepatopancreatoduodenectomy (HPD) is performed to achieve radical resection of malignant biliary tumors. We reviewed clinical outcomes to evaluate the utility of HPD in terms of morbidity and mortality.
  
  
  METHODS
  A retrospective analysis was conducted on 17 patients underwent HPD between August 1991 and May 2013; 9 bile duct cancer, 5 advanced gallbladder and 3 pancreatic tumor with liver metastasis.
  
  
  RESULTS
  The morbidity and mortality rates were 88.3% and 0%, respectively. Univariate analysis showed that a body mass index of ≥22 and preoperative total bilirubin level ≥0.8 mg/dl were significantly associated with severe complications. One-, 3- and 5-year survival rate were 73.3%, 60.0% and 30.0%. In 14 patients with biliary carcinoma, univariate analysis showed that a histological grade of G1 was significantly associated with survival. Patients without pancreatic invasion or portal vein invasion tended to survive longer than patients with these types of invasion, although the difference was not significant.
  
  
  CONCLUSIONS
  HPD can be performed with no mortality and provides a survival benefit for some patients with biliary carcinoma undergoing curative resection. In patients with grade G1 biliary carcinoma without pancreatic or portal vein invasion in particular, this aggressive surgery might offer a chance of long-term survival.
authors.forename: Masashi
authors.initials: M
authors.lastname: Utsumi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Sadamori
authors.forename: Susumu
authors.initials: S
authors.lastname: Shinoura
authors.forename: Yuzo
authors.initials: Y
authors.lastname: Umeda
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Yoshida
authors.forename: Daisuke
authors.initials: D
authors.lastname: Nobuoka
authors.forename: Kosei
authors.initials: K
authors.lastname: Takagi
authors.forename: Toshiyoshi
authors.initials: T
authors.lastname: Fujiwara
authors.forename: Takahito
authors.initials: T
authors.lastname: Yagi
mesh_terms: D000328:Adult; D000368:Aged; D001650:Bile Duct Neoplasms / Q000601:surgery*; D005260:Female; D005706:Gallbladder Neoplasms / Q000601:surgery*; D006498:Hepatectomy / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D016577:Pancreaticoduodenectomy / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate