Chinese Medical Journal (Dec 2022)

Hepatopancreatoduodenectomy for advanced biliary malignancies

  • Xiangsong Wu,
  • Maolan Li,
  • Wenguang Wu,
  • Xu’an Wang,
  • Huaifeng Li,
  • Runfa Bao,
  • Yijun Shu,
  • Jun Shen,
  • Jun Gu,
  • Xuefeng Wang,
  • Wei Gong,
  • Shuyou Peng,
  • Yingbin Liu,
  • Yanjie Yin,
  • Xiuyuan Hao

DOI
https://doi.org/10.1097/CM9.0000000000002067
Journal volume & issue
Vol. 135, no. 23
pp. 2851 – 2858

Abstract

Read online

Abstract. Background:. Hepatopancreatoduodenectomy (HPD) has been considered the only curative treatment for metastatic cholangiocarcinoma and some locally advanced gallbladder cancers (GBCs). However, HPD has not yet been included in treatment guidelines as a standard surgical procedure in consideration of its morbidity and mortality rates. The aim of this study was to evaluate the safety and effectiveness of HPD in treating biliary malignancies. Methods:. The medical records of 57 patients with advanced biliary cancer undergoing HPD from January 2009 to December 2019 were retrospectively retrieved. A case-control analysis was conducted at our department. Patients with advanced GBC who underwent HPD (HPD-GBC group) were compared with a control group (None-HPD-GBC group). Baseline characteristics, preoperative treatments, tumor pathologic features, operative results, and prognosis were assessed. Results:. Thirteen patients with cholangiocarcinoma and 44 patients with GBC underwent HPD at our department. Significant postoperative complications (grade III or greater) and postoperative pancreatic fistula were observed in 24 (42.1%) and 15 (26.3%) patients, respectively. One postoperative death occurred in the present study. Overall survival (OS) was longer in patients with advanced cholangiocarcinoma than in those with GBC (median survival time [MST], 31 months vs. 11 months; P < 0.001). In the subgroup analysis of patients with advanced GBC, multivariate analysis demonstrated that T4 stage tumors (P = 0.012), N2 tumors (P = 0.001), and positive margin status (P = 0.004) were independently associated with poorer OS. Patients with either one or more prognostic factors exhibited a shorter MST than patients without those prognostic factors (P < 0.001). Conclusion:. HPD could be performed with a relatively low mortality rate and an acceptable morbidity rate in an experienced high- volume center. For patients with advanced GBC without an N2 or T4 tumor, HPD can be a preferable treatment option.