Premium
Review of hepatopancreatoduodenectomy for biliary cancer: an extended radical approach of J apanese origin
Author(s) -
Ebata Tomoki,
Yokoyama Yukihiro,
Igami Tsuyoshi,
Sugawara Gen,
Mizuno Takashi,
Nagino Masato
Publication year - 2014
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.80
Subject(s) - medicine , gallbladder cancer , perioperative , gallbladder , cholecystectomy , portal vein , resection , cancer , biliary tract cancer , surgery , general surgery , gastroenterology , gemcitabine
Cholangiocarcinomas exhibit various modes of local extension, and some tumors can only be completely resected by hepatopancreatoduodenectomy ( HPD ), which is defined as the resection of the whole extrahepatic biliary system with the adjacent liver and pancreatoduodenum. Since T akasaki et al. introduced HPD for locally advanced gallbladder cancer in 1980, Japanese hepatobiliary surgeons have aggressively challenged this extended procedure for advanced biliary tumors. Early experiences with HPD were frequently associated with liver failure and sequential mortality, leading to an underestimation of the survival benefit of HPD . However, with improvements in surgical techniques and perioperative patient care, including portal vein embolization, over the last two decades, the mortality rate after HPD has gradually decreased. Recent studies have demonstrated a favorable survival in cholangiocarcinoma, provided that R0 resection is achieved. In contrast, HPD for gallbladder cancer remains controversial because of the extremely poor survival, although the study populations have been limited. HPD can be performed with low mortality and offers a better probability of long‐term survival in patients with cholangiocarcinoma. We should consider HPD to be a standard approach for laterally advanced cholangiocarcinomas that are otherwise unresectable.