THE LARGEST WESTERN EXPERIENCE WITH HEPATOPANCREATODUODENECTOMY: LESSONS LEARNED WITH 35 CASES.
BACKGROUND
Hepatopancreatoduodenectomy is one of the most complex abdominal operations mainly indicated in advanced biliary carcinoma.


OBJECTIVE
To present 10-year experience performing this operation in advanced malignant tumors.


METHODS
This is a retrospective descriptive study. From 2004 to 2014, 35 hepatopancreatoduodenectomies were performed in three different institutions. The most common indication was advanced biliary carcinoma in 24 patients (68.5%).


RESULTS
Eighteen patients had gallbladder cancer, eight Klatskin tumors, five neuroendocrine tumors with liver metastasis, one colorectal metastasis invading the pancreatic head, one intraductal papillary mucinous neoplasm with liver metastasis, one gastric cancer recurrence with liver involvement and one ocular melanoma with pancreatic head and right liver lobe metastasis. All patients were submitted to pancreatoduodenectomy with a liver resection as follows: eight right trisectionectomies, five right lobectomies, four left lobectomies, 18 central lobectomies (IVb, V and VIII). The overall mortality was 34.2% (12/35) and the overall morbidity rate was 97.4%.


CONCLUSIONS
Very high mortality is seen when major liver resection is performed with pancreatoduodenectomy, including right lobectomy and trisectionectomy. Liver failure in combination with a pancreatic leak is invariably lethal. Efforts to ensure a remnant liver over 40-50% of the total liver volume are the key to obtain patient survival.
Department of Surgery, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
Eduardo de Souza Martins
Ede S
Fernandes
Department of Surgery and Transplantation of Rio de Janeiro, Adventist Hospital, Rio de Janeiro, RJ, Brazil.
Felipe Tavares de
FT
Mello
Department of Surgery, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
Joaquim
J
Ribeiro-Filho
Department of Surgery, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
Asterio Pinto do
AP
Monte-Filho
Department of Digestive Surgery, Pio XII Hospital, São Jose dos Campos, SP, Brazil.
Moacir Martins
MM
Fernandes
Department of Surgery and Transplantation of Rio de Janeiro, Adventist Hospital, Rio de Janeiro, RJ, Brazil.
Romulo Juventino
RJ
Coelho
Department of Surgery and Transplantation of Rio de Janeiro, Adventist Hospital, Rio de Janeiro, RJ, Brazil.
Monique Couto
MC
Matos
Department of Surgery, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
Antonio Augusto Peixoto de
AA
Souza
Department of Surgery, Federal University of Maranhão, MA, Brazil.
Orlando Jorge Martins
OJ
Torres
D000368:Aged; D001661:Biliary Tract Neoplasms / Q000601:surgery*; D004379:Duodenal Neoplasms / Q000601:surgery*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000601:surgery*; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D012189:Retrospective Studies