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The Short- and Long-Term Surgical Results of Consecutive Hepatopancreaticoduodenectomy for Wide-Spread Biliary Malignancy

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

Abstract

Background

Cancer-free resection (R0) is one of the most important factors for the long-term survival of biliary carcinoma. For some patients with widespread invasive cancer located between the hilar and intrapancreatic bile duct, hepatopancreaticoduodenectomy (HPD) is considered a radical surgery for R0 resection. However, HPD is associated with high morbidity and mortality rates. Furthermore, previous reports have not shown lymph node metastasis (LNM) status, such as the location or number, which could influence the prognosis after HPD. In this study, first, we explored the prognostic factors for survival, and second, we evaluated whether the LNM status (number and location of LNM) would influence the decision on surgical indications in patients with widely spread biliary malignancy.

Methods

We retrospectively reviewed the medical records of 54 patients who underwent HPD with hepatectomy in ≥2 liver sectors from January 2003 to December 2021 (HPD-G). We also evaluated 54 unresectable perihilar cholangiocarcinoma patients who underwent chemotherapy from January 2010 to December 2021 (CTx-G).

Results

R0 resection was performed in 48 patients (89%). The median survival time (MST) and 5-year overall survival rate of the HPD-G and CTx-G groups were 36.9 months and 31.1%, and 19.6 months and 0%, respectively. Univariate and multivariate analyses showed that pathological portal vein involvement was an independent prognostic factor for survival (MST: 18.9 months). Additionally, patients with peripancreatic LNM had worse prognoses (MST: 13.3 months) than CTx-G.

Conclusions

Patients with peripancreatic LNM or PV invasion might be advised to be excluded from surgery-first indications for HPD.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Sapporo, Japan

    Yasunori Yoshimi MD, Takehiro Noji MD, PhD, Keisuke Okamura MD, PhD, Kimitaka Tanaka MD, PhD, Aya Matsui MD, PhD, Yoshitsugu Nakanishi MD, PhD, Toshimichi Asano MD, PhD, Toru Nakamura MD, PhD, Takahiro Tsuchikawa MD, PhD & Satoshi Hirano MD, PhD

  2. Department of Gastroenterology, Faculty of Medicine, Hokkaido University, Sapporo, Japan

    Yasuyuki Kawamoto MD, PhD & Kazuaki Harada MD, PhD

  3. Department of Biostatistics, Faculty of Medicine, Hokkaido University, Sapporo, Japan

    Kanako Fuyama MASc & Kazuhumi Okada MPH

Authors
  1. Yasunori Yoshimi MD
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  2. Takehiro Noji MD, PhD
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  3. Keisuke Okamura MD, PhD
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  14. Satoshi Hirano MD, PhD
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Correspondence to Takehiro Noji MD, PhD.

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Yoshimi, Y., Noji, T., Okamura, K. et al. The Short- and Long-Term Surgical Results of Consecutive Hepatopancreaticoduodenectomy for Wide-Spread Biliary Malignancy. Ann Surg Oncol 31, 90–96 (2024). https://doi.org/10.1245/s10434-023-14406-2

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