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

doi:10.1097/CM9.0000000000002067

Hepatopancreatoduodenectomy for advanced biliary malignancies

Chin Med J (Engl). 2022 Dec 5;135(23):2851-2858. doi: 10.1097/CM9.0000000000002067.

Authors

Xiangsong Wu^{1

2

3}, Maolan Li^{1

2

3}, Wenguang Wu^{4

5

2

3}, Xu'an Wang^{4

5

2

3}, Huaifeng Li^{1

2

3}, Runfa Bao^{1

2

3}, Yijun Shu^{1

2

3}, Jun Shen^{1

2

3}, Jun Gu^{1

2

3}, Xuefeng Wang^{1

2

3}, Wei Gong^{1

2

3}, Shuyou Peng⁶, Yingbin Liu^{4

5

2

3}

Affiliations

¹ Department of General Surgery, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China.
² Shanghai Key Laboratory of Biliary Tract Disease Research, Shanghai 200092, China.
³ Shanghai Research Center of Biliary Tract Disease, Shanghai 200092, China.
⁴ Department of Biliary-Pancreatic Surgery, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China.
⁵ State Key Laboratory of Oncogenes and Related Genes, Shanghai 200092, China.
⁶ Department of General Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejing 310009, China.

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.

MeSH terms

Bile Duct Neoplasms* / pathology
Bile Ducts, Intrahepatic / pathology
Bile Ducts, Intrahepatic / surgery
Cholangiocarcinoma* / pathology
Cholangiocarcinoma* / surgery
Gallbladder Neoplasms* / pathology
Hepatectomy / methods
Humans
Pancreaticoduodenectomy / adverse effects
Pancreaticoduodenectomy / methods
Postoperative Complications
Retrospective Studies