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Combined Major Hepatectomy and Pancreaticoduodenectomy for Locally Advanced Biliary Carcinoma: Long-Term Results

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Abstract

Background

This study aimed to define the role of combined major hepatectomy and pancreaticoduodenectomy in the surgical management of biliary carcinoma and to identify potential candidates for this aggressive procedure.

Methods

A retrospective analysis was conducted on 28 patients who underwent a combined major hepatectomy and pancreaticoduodenectomy for extrahepatic cholangiocarcinoma (n = 17) or gallbladder carcinoma (n = 11). Major hepatectomy was defined as hemihepatectomy or more extensive hepatectomy. Altogether, 11 patients underwent a Whipple procedure, and 17 had a pylorus-preserving pancreaticoduodenectomy. The median follow-up time was 169 months.

Results

Morbidity and in-hospital mortality were 82% and 21%, respectively. Overall cumulative survival rates after resection were 32% at 2 years and 11% at 5 years (median survival time 9 months). The median survival time was 6 months with a 2-year survival rate of 0% in 11 patients with residual tumor, whereas the median survival time was 26 months with a 5-year survival rate of 18% in 17 patients with no residual tumor (P = 0.0012). Residual tumor status was the only independent prognostic factor of significance (relative risk 4.65; P = 0.003). There were three 5-year survivors (two with diffuse cholangiocarcinoma and one with gallbladder carcinoma with no bile duct involvement) among the patients with no residual tumor.

Conclusions

Combined major hepatectomy and pancreaticoduodenectomy provides survival benefit for some patients with locally advanced biliary carcinoma only if potentially curative (R0) resection is feasible. Patients with diffuse cholangiocarcinoma and gallbladder carcinoma with no bile duct involvement are potential candidates for this aggressive procedure.

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References

  1. Klempnauer J, Ridder GJ, Werner M, et al. (1997) What constitutes long-term survival after surgery for hilar cholangiocarcinoma? Cancer 79:26–34

    Article  PubMed  CAS  Google Scholar 

  2. Chamberlain RS, Blumgart LH (2000) Hilar cholangiocarcinoma: a review and commentary. Ann Surg Oncol 7:55–66

    Article  PubMed  CAS  Google Scholar 

  3. Bartlett DL, Fong Y, Fortner JG, et al. (1996) Long-term results after resection for gallbladder cancer: implications for staging and management. Ann Surg 224:639–646

    Article  PubMed  CAS  Google Scholar 

  4. Dixon E, Vollmer CM Jr, Sahajpal A, et al. (2005) An aggressive surgical approach leads to improved survival in patients with gallbladder cancer: a 12-year study at a North American Center. Ann Surg 241:385–394

    Article  PubMed  Google Scholar 

  5. Shirai Y, Wakai T, Hatakeyama K (2007) Radical lymph node dissection for gallbladder cancer: indications and limitations. Surg Oncol Clin N Am 16:221–232

    Article  PubMed  Google Scholar 

  6. Takasaki K, Kobayashi S, Mutou H, et al. (1980) [Our experiences (5 cases) of extended right lobectomy combined with pancreato-duodenectomy for the carcinoma of the gall bladder.] Tan to Sui 1:923–932 (in Japanese)

    Google Scholar 

  7. Nimura Y, Hayakawa N, Kamiya J, et al. (1991) Hepatopancreatoduodenectomy for advanced carcinoma of the biliary tract. Hepatogastroenterology 38:170–175

    PubMed  CAS  Google Scholar 

  8. Mimura H, Takakura N, Kim H, et al. (1991) Block resection of the hepatoduodenal ligament for carcinoma of the bile duct and gallbladder: surgical technique and a report of 11 cases. Hepatogastroenterology 38:561–567

    PubMed  CAS  Google Scholar 

  9. Ogura Y, Mizumoto R, Isaji S, et al. (1991) Radical operations for carcinoma of the gallbladder: present status in Japan. World J Surg 15:337–343

    Article  PubMed  CAS  Google Scholar 

  10. Nakamura S, Nishiyama R, Yokoi Y, et al. (1994) Hepatopancreatoduodenectomy for advanced gallbladder carcinoma. Arch Surg 129:625–629

    PubMed  CAS  Google Scholar 

  11. Tsukada K, Yoshida K, Aono T, et al. (1994) Major hepatectomy and pancreatoduodenectomy for advanced carcinoma of the biliary tract. Br J Surg 81:108–110

    Article  PubMed  CAS  Google Scholar 

  12. Miyazaki K, Tsutsumi N, Kitahara K, et al. (1995) Hepatopancreatoduodenectomy for squamous and adenosquamous carcinoma of the gallbladder. Hepatogastroenterology 42:47–50

    PubMed  CAS  Google Scholar 

  13. Miyagawa S, Makuuchi M, Kawasaki S, et al. (1996) Outcome of major hepatectomy with pancreatoduodenectomy for advanced biliary malignancies. World J Surg 20:77–80

    Article  PubMed  CAS  Google Scholar 

  14. Miyazaki M, Itoh H, Ambiru S, et al. (1996) Radical surgery for advanced gallbladder carcinoma. Br J Surg 83:478–481

    Article  PubMed  CAS  Google Scholar 

  15. Shirai Y, Ohtani T, Tsukada K, et al. (1997) Combined pancreaticoduodenectomy and hepatectomy for patients with locally advanced gallbladder carcinoma: long term results. Cancer 80:1904–1909

    Article  PubMed  CAS  Google Scholar 

  16. Kondo S, Nimura Y, Hayakawa N, et al. (2002) Extensive surgery for carcinoma of the gallbladder. Br J Surg 89:179–184

    PubMed  CAS  Google Scholar 

  17. Araida T, Yoshikawa T, Azuma T, et al. (2004) Indications for pancreatoduodenectomy in patients undergoing lymphadenectomy for advanced gallbladder carcinoma. J Hepatobiliary Pancreat Surg 11:45–49

    Article  PubMed  Google Scholar 

  18. Hirono S, Tani M, Kawai M, et al. (2006) Indication of hepatopancreatoduodenectomy for biliary tract cancer. World J Surg 30:567–573

    Article  PubMed  Google Scholar 

  19. Nakamura S, Suzuki S, Serizawa A, et al. (1996) Hepatopancreatoduodenectomy for superficially spreading bile duct carcinoma: a report of two 5 year survivals. Hepatogastroenterology 43:138–142

    PubMed  CAS  Google Scholar 

  20. Chijiiwa K, Nishiyama K, Takashima M, et al. (1999) Diffuse bile duct carcinoma treated by major hepatectomy and pancreatoduodenectomy with the aid of pre-operative portal vein embolization: report of two cases. Hepatogastroenterology 46:1634–1638

    PubMed  CAS  Google Scholar 

  21. Yoshimi F, Asato Y, Amemiya R, et al. (2001) Comparison between pancreatoduodenectomy and hepatopancreatoduodenectomy for bile duct cancer. Hepatogastroenterology 48:994–998

    PubMed  CAS  Google Scholar 

  22. D’Angelica M, Martin RC 2nd, Jarnagin WR, et al. (2004) Major hepatectomy with simultaneous pancreatectomy for advanced hepatobiliary cancer. J Am Coll Surg 198:570–576

    Article  PubMed  Google Scholar 

  23. Windsor JA (2006) Indication for hepatopancreatoduodenectomy in biliary tract cancer. World J Surg 30:574–575

    Article  Google Scholar 

  24. Greene FL, Page DL, Fleming ID, et al. (2002) American Joint Committee on Cancer Staging Manual. 6th edition. Springer, New York, pp 139–150

    Google Scholar 

  25. Terminology Committee of the International Hepato-Pancreato-Biliary Association (2000) The Brisbane 2000 terminology of liver anatomy and resections. HPB 2:333–339

    Google Scholar 

  26. Shirai Y, Yoshida K, Tsukada K, et al. (1992) Inapparent carcinoma of the gallbladder: an appraisal of a radical second operation after simple cholecystectomy. Ann Surg 215:326–331

    Article  PubMed  CAS  Google Scholar 

  27. Shirai Y, Yoshida K, Tsukada K, et al. (1992) Identification of the regional lymphatic system of the gallbladder by vital staining. Br J Surg 79:659–662

    Article  PubMed  CAS  Google Scholar 

  28. Shirai Y, Ohtani T, Tsukada K, et al. (1997) Patterns of lymphatic spread of carcinoma of the ampulla of Vater. Br J Surg 84:1012–1016

    Article  PubMed  CAS  Google Scholar 

  29. Tompkins RK, Thomas D, Wile A, et al. (1981) Prognostic factors in bile duct carcinoma: analysis of 96 cases. Ann Surg 194:447–457

    Article  PubMed  CAS  Google Scholar 

  30. Wakai T, Shirai Y, Moroda T, et al. (2005) Impact of ductal resection margin status on long-term survival in patients undergoing resection for extrahepatic cholangiocarcinoma. Cancer 103:1210–1216

    Article  PubMed  Google Scholar 

  31. Wakai T, Shirai Y, Yokoyama N, et al. (2003) Depth of subserosal invasion predicts long-term survival after resection in patients with T2 gallbladder carcinoma. Ann Surg Oncol 10:447–454

    Article  PubMed  Google Scholar 

  32. Oohashi Y, Shirai Y, Wakai T, et al. (2002) Adenosquamous carcinoma of the gallbladder warrants resection only if curative resection is feasible. Cancer 94:3000–3005

    Article  PubMed  Google Scholar 

  33. Doty JR, Cameron JL, Yeo CJ, et al. (2002) Cholecystectomy, liver resection, and pylorus-preserving pancreaticoduodenectomy for gallbladder cancer: report of five cases. J Gastrointest Surg 6:776–780

    Article  PubMed  Google Scholar 

  34. Sasaki R, Itabashi H, Fujita T, et al. (2006) Significance of extensive surgery including resection of the pancreas head for the treatment of gallbladder cancer—from the perspective of mode of lymph node involvement and surgical outcome. World J Surg 30:36–42

    Article  PubMed  Google Scholar 

  35. Aloia TA, Charnsangavej C, Faria S, et al. (2007) High-resolution computed tomography accurately predicts resectability in hilar cholangiocarcinoma. Am J Surg 193:702–706

    Article  PubMed  Google Scholar 

  36. D’Angelica M, Fong Y, Weber S, et al. (2003) The role of staging laparoscopy in hepatobiliary malignancy: prospective analysis of 401 cases. Ann Surg Oncol 10:183–189

    Article  PubMed  CAS  Google Scholar 

  37. Kaneoka Y, Yamaguchi A, Isogai M (2007) Hepatopancreatoduodenectomy: its suitability for bile duct cancer versus gallbladder cancer. J Hepatobiliary Pancreat Surg 14:142–148

    Article  PubMed  Google Scholar 

  38. Sakamoto E, Nimura Y, Hayakawa N, et al. (1998) The pattern of infiltration at the proximal border of hilar bile duct carcinoma: a histologic analysis of 62 resected cases. Ann Surg 227:405–411

    Article  PubMed  CAS  Google Scholar 

  39. Ebata T, Watanabe H, Ajioka Y, et al. (2002) Pathological appraisal of lines of resection for bile duct carcinoma. Br J Surg 89:1260–1267

    Article  PubMed  CAS  Google Scholar 

  40. Wakai T, Shirai Y, Hatakeyama K (2005) Peroral cholangioscopy for non-invasive papillary cholangiocarcinoma with extensive superficial ductal spread. World J Gastroenterol 11:6554–6556

    PubMed  Google Scholar 

  41. Kaneoka Y, Yamaguchi A, Isogai M, et al. (2003) Hepatoduodenal ligament invasion by gallbladder carcinoma: histologic patterns and surgical recommendation. World J Surg 27:260–265

    Article  PubMed  Google Scholar 

  42. Endo I, Shimada H, Fujii Y, et al. (2001) Indications for curative resection of advanced gallbladder cancer with hepatoduodenal ligament invasion. J Hepatobiliary Pancreat Surg 8:505–510

    Article  PubMed  CAS  Google Scholar 

  43. Hawkins WG, DeMatteo RP, Jarnagin WR, et al. (2004) Jaundice predicts advanced disease and early mortality in patients with gallbladder cancer. Ann Surg Oncol 11:310–315

    Article  PubMed  Google Scholar 

  44. Miwa S, Kobayashi A, Akahane Y, et al. (2007) Is major hepatectomy with pancreatoduodenectomy justified for advanced biliary malignancy? J Hepatobiliary Pancreat Surg 14:136–141

    Article  PubMed  Google Scholar 

  45. Kondo S, Nimura Y, Kamiya J, et al. (2001) Five-year survivors after aggressive surgery for stage IV gallbladder cancer. J Hepatobiliary Pancreat Surg 8:511–517

    Article  PubMed  CAS  Google Scholar 

  46. Shirai Y, Yamai K, Ohtani T, et al. (1997) A new technique for assessing the resectability of hilar cholangiocarcinoma: lifting of the umbilical portion of the portal vein. J Am Coll Surg 184:80–83

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, 951-8510, Japan

    Toshifumi Wakai, Yoshio Shirai & Katsuyoshi Hatakeyama

  2. Department of Surgery, Niigata Cancer Center Hospital, 2-15-3 Kawagishi-cho, Chuo-ku, Niigata, 951-8566, Japan

    Yoshiaki Tsuchiya & Tatsuya Nomura

  3. Department of Medical Informatics, Niigata University Medical and Dental Hospital, 1–754 Asahimachi-dori, Chuo-ku, Niigata, 951-8520, Japan

    Kouhei Akazawa

Authors
  1. Toshifumi Wakai
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  2. Yoshio Shirai
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  3. Yoshiaki Tsuchiya
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  4. Tatsuya Nomura
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  5. Kouhei Akazawa
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  6. Katsuyoshi Hatakeyama
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Correspondence to Yoshio Shirai.

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Wakai, T., Shirai, Y., Tsuchiya, Y. et al. Combined Major Hepatectomy and Pancreaticoduodenectomy for Locally Advanced Biliary Carcinoma: Long-Term Results. World J Surg 32, 1067–1074 (2008). https://doi.org/10.1007/s00268-007-9393-8

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  • DOI: https://doi.org/10.1007/s00268-007-9393-8

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