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Safety and Oncological Benefit of Hepatopancreatoduodenectomy for Advanced Extrahepatic Cholangiocarcinoma with Horizontal Tumor Spread: Shinshu University Experience

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Although hepatopancreatoduodenectomy (HPD) is the only means of achieving R0 resection of widespread extrahepatic cholangiocarcinoma, its safety and oncological benefit remain controversial because of its inherent high risk of mortality and morbidity.

Objective

The aim of this study was to retrospectively analyze short- and long-term outcomes and evaluate the safety and oncological benefit of this advanced procedure.

Methods

The study cohort comprised 37 consecutive patients who had undergone major HPD. Portal vein embolization was performed before surgery in 20 (54%) patients with future remnant liver volume < 35%.

Results

The median operative time and blood loss were 866 min and 1000 mL, respectively. Concomitant vascular resection was performed in five patients (14%). The overall morbidity and mortality rates were 100% and 5.4% (n = 2), respectively. Nineteen patients (51%) had major (Clavien–Dindo grade III or higher) complications, the most common being intra-abdominal infection (49%) and post-hepatectomy liver failure (46%, grade B/C: 32%/5%), followed by postoperative pancreatic fistula (30%, grade B/C). R0 resection was achieved in 31 patients (84%). The 1-, 3-, and 5-year overall survival (OS) rates were 83%, 48%, and 37%, respectively. In patients with R0 resection, 5-year OS was comparable between patients who had undergone major HPD and major hepatectomy alone (41% vs. 40%, p = non-significant).

Conclusions

HPD is a valid treatment option for extensive cholangiocarcinoma, offering long-term survival benefit at the cost of relatively high but acceptable morbidity and mortality rates. HPD is advocated in selected patients provided that it is considered possible to achieve R0 resection.

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Acknowledgment

The authors thank Rebecca Tollefson, DVM, from Edanz Group (https://en-author-services.edanzgroup.com/) for editing a draft of this manuscript.

Funding

No funding was received specifically for this study.

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Authors and Affiliations

  1. Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan

    Akira Shimizu MD, PhD, Hiroaki Motoyama MD, PhD, Koji Kubota MD, PhD, Tsuyoshi Notake MD, PhD, Kentaro Fukushima MD, Tomohiko Ikehara MD, Hikaru Hayashi MD, Koya Yasukawa MD, Akira Kobayashi MD, PhD & Yuji Soejima MD, PhD

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  1. Akira Shimizu MD, PhD
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  2. Hiroaki Motoyama MD, PhD
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  4. Tsuyoshi Notake MD, PhD
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  5. Kentaro Fukushima MD
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  6. Tomohiko Ikehara MD
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  10. Yuji Soejima MD, PhD
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Correspondence to Akira Shimizu MD, PhD.

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Akira Shimizu, Hiroaki Motoyama, Koji Kubota, Tsuyoshi Notake, Kentaro Fukushima, Tomohiko Ikehara, Hikaru Hayashi, Koya Yasukawa, Akira Kobayashi, and Yuji Soejima have no conflicts of interest to declare.

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Shimizu, A., Motoyama, H., Kubota, K. et al. Safety and Oncological Benefit of Hepatopancreatoduodenectomy for Advanced Extrahepatic Cholangiocarcinoma with Horizontal Tumor Spread: Shinshu University Experience. Ann Surg Oncol 28, 2012–2025 (2021). https://doi.org/10.1245/s10434-020-09209-8

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  • DOI: https://doi.org/10.1245/s10434-020-09209-8

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