Hepatopancreatoduodenectomy In Biliary Tract Cancer

BACKGROUND:Biliary cancers are rare incidence of malignancy that associated with dismal prognosis due to its late presentation and mostly asymptomatic in early stage of cancer.A curative negative margin resection is the only way of treatment to cure the disease.However,in terms of advanced disease,an aggressive approach is needed and it comes with high morbidity and mortality rates.Hepatopancreatoduodenectomy(HPD)is one of the highly aggressive surgical treatment for biliary tract tumors that can provide RO resection.The aim of this study was to evaluate the survival benefit of HPD and analyzed the risk factors of major complications for gallbladder and extrahepatic cholangiocarcinoma patients to reduce the postoperative complications and nortality.METHODS:In total of 38 patients of gallbladder and extrahepatic cholangiocarcinoma patients who received HPD were collected retrospectively between 2011 and 2017 in our center.Univariate and multivariate analysis were conducted to analyzed the prognostic and risk factor post-operative HPD treatment.RESULTS:The 1-,2-,3-year overall survival(OS)after HPD surgery were 39.4%,31.5%,and 23%,respectively and the median OS is 9 months(range 1-88 months).Obstructive jaundice,neutrophil-to-lymphocyte ratio(NLR),serum CA 19-9 levels,and hepatic artery(HA)reconstruction and resection(P value 0.026,0.025,0.034,<0.001,respectively)are statistically significant with overall survival in both diseases.HA resection is the independent prognostic factor of survival after HPD.Lower preoperative bilirubin levels,and no obstructive jaundice have increase overall survival(OS)in gallbladder cancer patients.BMI,ICU stay,operative hours,homologous intraoperative blood transfusion,hepatectomy type,and combined resection have significantly associated with major complications(P<0.05).CONCLUSIONS:Hepatopancreatoduodenectomy is an aggressive surgical approach that comes with a high risk of major complications and mortality.Despite all of the risks,this procedure could be considered to achieve a curative negative surgical margin for those resectable advanced biliary cancer patients.With strict preoperative evaluation and selection of patients,HPD can provide long-term benefit survival time.