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.

Hepatectomy;Hepatopancreatoduodenectomy;Gallbladder cancer;Cholangiocarcinoma

Wu Xiangsong;Li Maolan;Wu Wenguang;Wang Xu’an;Li Huaifeng;Bao Runfa;Shu Yijun;Shen Jun;Gu Jun;Wang Xuefeng;Gong Wei;Peng Shuyou;Liu Yingbin

Department of General Surgery, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China;Shanghai Key Laboratory of Biliary Tract Disease Research, Shanghai 200092, China;Shanghai Research Center of Biliary Tract Disease, Shanghai 200092, China;Department of Biliary-Pancreatic Surgery, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China;State Key Laboratory of Oncogenes and Related Genes, Shanghai 200092, China;Department of General Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejing 310009, China

中华医学杂志（英文版）

[1]Wu Xiangsong;Li Maolan;Wu Wenguang;Wang Xu’an;Li Huaifeng;Bao Runfa;Shu Yijun;Shen Jun;Gu Jun;Wang Xuefeng;Gong Wei;Peng Shuyou;Liu Yingbin-.Hepatopancreatoduodenectomy for advanced biliary malignancies)[J].中华医学杂志（英文版）,2022(23):2851-2858

Hepatopancreatoduodenectomy,GBCs

advanced,biliary,malignancies,Background,HPD,has,been,considered,only,curative,metastatic,cholangiocarcinoma,some,locally,gallbladder,cancers,However,not,yet,included,guidelines,standard,surgical,procedure,consideration,its,morbidity,mortality,rates,aim,this,study,was,evaluate,safety,effectiveness,treating,Methods,medical,records,patients,undergoing,from,January,December,were,retrospectively,retrieved,case,control,analysis,conducted,our,department,Patients,who,underwent,compared,None,Baseline,characteristics,preoperative,treatments,pathologic,features,results,prognosis,assessed,Results,Thirteen,Significant,postoperative,complications,grade,III,greater,pancreatic,fistula,observed,respectively,One,death,occurred,present,Overall,survival,OS,longer,than,those,median,MST,months,In,subgroup,multivariate,demonstrated,that,T4,stage,tumors,N2,positive,margin,status,independently,associated,poorer,either,more,prognostic,factors,exhibited,shorter,without,Conclusion,could,performed,relatively,low,acceptable,experienced,high,volume,center,For,preferable,option,Hepatectomy,Gallbladder,Cholangiocarcinoma

0.528371