Hepatopancreatoduodenectomy -a controversial treatment for bile duct and gallbladder cancer from a European perspective

Melroy A D'Souza, Valentinus T Valdimarsson, Tommaso Campagnaro, Francois Cauchy, Nikolaos A Chatzizacharias, Mathieu D'Hondt, Bobby Dasari, Alessandro Ferrero, Lotte C Franken, Giuseppe Fusai, Alfredo Guglielmi, Jeroen Hagendoorn, Camila Hidalgo Salinas, Frederik J H Hoogwater, Rosa Jorba, Nariman Karanjia, Wolfram T Knoefel, Philipp Kron, Rajiv Lahiri, Serena LangellaBertrand Le Roy, Nadja Lehwald-Tywuschik, Mickael Lesurtel, Jun Li, J Peter A Lodge, Erini Martinou, Izaak Q Molenaar, Andrej Nikov, Ignasi Poves, Fadi Rassam, Nadia Russolillo, Olivier Soubrane, Stefan Stättner, Ronald M van Dam, Thomas M van Gulik, Alejandro Serrablo, Tom M Gallagher, Christian Sturesson*, E-AHPBA scientific and research committee

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

14 Citations (Web of Science)

Abstract

BACKGROUND: Hepatopancreatoduodenectomy (HPD) is an aggressive operation for treatment of advanced bile duct and gallbladder cancer associated with high perioperative morbidity and mortality, and uncertain oncological benefit in terms of survival. Few reports on HPD from Western centers exist. The purpose of this study was to evaluate safety and efficacy for HPD in European centers.

METHOD: Members of the European-African HepatoPancreatoBiliary Association were invited to report all consecutive patients operated with HPD for bile duct or gallbladder cancer between January 2003 and January 2018. The patient and tumor characteristics, perioperative and survival outcomes were analyzed.

RESULTS: In total, 66 patients from 19 European centers were included in the analysis. 90-day mortality rate was 17% and 13% for bile duct and gallbladder cancer respectively. All factors predictive of perioperative mortality were patient and disease-specific. The three-year overall survival excluding 90-day mortality was 80% for bile duct and 30% for gallbladder cancer (P = 0.013). In multivariable analysis R0-resection had a significant impact on overall survival.

CONCLUSION: HPD, although being associated with substantial perioperative mortality, can offer a survival benefit in patient subgroups with bile duct cancer and gallbladder cancer. To achieve negative resection margins is paramount for an improved survival outcome.

Original languageEnglish
Pages (from-to)1339-1348
Number of pages10
JournalHPB
Volume22
Issue number9
Early online date30 Dec 2019
DOIs
Publication statusPublished - Sep 2020

Keywords

  • INTERNATIONAL STUDY-GROUP
  • MAJOR HEPATECTOMY
  • PERIHILAR CHOLANGIOCARCINOMA
  • RISK SCORE
  • PANCREATIC FISTULA
  • BILIARY
  • RESECTION
  • LIVER
  • PANCREATICODUODENECTOMY
  • DEFINITION

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