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Right hepatopancreatoduodenectomy: improvements over 23 years to attain acceptability
Author(s) -
Ebata Tomoki,
Nagino Masato,
Nishio Hideki,
Arai Toshiyuki,
Nimura Yuji
Publication year - 2007
Publication title -
journal of hepato‐biliary‐pancreatic surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 0944-1166
DOI - 10.1007/s00534-006-1106-4
Subject(s) - medicine , blood loss , surgery , perioperative , incidence (geometry) , pancreatic cancer , general surgery , cancer , physics , optics
Background/Purpose Right hepatopancreatoduodenectomy (rt‐HPD), a demanding procedure associated with high morbidity and mortality, remains the only curative option for some patients with biliary cancer. We retrospectively analyzed our progress over 23 years in making this operation safer. Methods Fifty‐eight patients who had undergone rt‐HPD were enrolled. Gallbladder cancer was present in 33 patients and bile duct cancer in 25 patients. Comparisons of short‐term results after surgery were made between the 1980s (16 patients), 1990s (28 patients), and 2000 to 2004 (14 patients). Results Intraoperative blood loss decreased progressively and significantly. The incidence of pancreatic fistula, and leakage of pancreatojejunostomy and hepaticojejunostomy also decreased, as did the occurrence of liver failure. Infection varied little by decade, but some recent progress may be underway. Mortality decreased, although not significantly. Conclusions Refinements in techniques, imaging, and perioperative management have improved the outlook for patients requiring HPD for cure, but much more remains to be achieved. Our results are not satisfactory, but they may be acceptable, considering the lack of alternative curative treatment.