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Central hepatectomy with pancreatoduodenectomy for diffusely spread bile duct cancer
Author(s) -
Mizuno Takashi,
Kanemoto Hideyuki,
Sugiura Teiichi,
Okamura Yukiyasu,
Uesaka Katsuhiko
Publication year - 2015
Publication title -
journal of hepato‐biliary‐pancreatic sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 1868-6974
DOI - 10.1002/jhbp.197
Subject(s) - medicine , hepatectomy , bile duct cancer , concomitant , bile duct , surgery , resection , cancer
Background Major hepatectomy with concomitant pancreatoduodenectomy (major‐ HPD ) is the only procedure that provides a curative resection for diffusely spread extrahepatic bile duct cancer ( DSEBDC ). We sometimes encounter patients who cannot undergo major‐ HPD because of a poor functional hepatic reserve. The aim of the present study was to assess the feasibility of central hepatectomy with pancreatoduodenectomy (central‐ HPD ) for patients with DSEBDC as an alternative to major‐ HPD . Methods Between 2002 and 2010, six patients with DSEBDC underwent central‐ HPD . The hepatectomy procedures for central‐ HPD included central bisectionectomy with S1 resection ( S1r ) and right anterior sectionectomy with S 1r. Results The estimated resection liver volume was decreased from 77.5% to 46.6% by the application of central‐ HPD . The median operative duration was 929 min, and the median blood loss was 2568 ml. Postoperative complications were observed in five patients. The proximal ductal stump was histologically positive with non‐invasive cancer in three patients and positive with invasive cancer in one. The overall survival of the six patients was 62.5% at 5 years after surgery. Conclusions While central‐ HPD was a technically complicated procedure associated with a high morbidity rate, it offered a favorable overall survival and might be an alternative option for DSEBDC patients with a poor hepatic functional reserve.