Single-center Experience Analysis Of Hepatopancreatoduodenectomy(HPD)

Background:As to the patients with some malignant biliary diseases that cannot be resected in a conventional way including the advanced bile duct cancer and gallbladder carcinoma as well as locally invasive gastrointestinal malignant tumors,the patients' survival prognosis is usually extremely poor due to the failure of operation to achieve RO resection.It was firstly reported by Takasaki et al in 1980 that,hepatopancreatoduodenectomy(HPD)had been applied to 5 cases of patient with locally invasive gallbladder carcinoma,among whom the maximal postoperative survival time was 16 months at the time.since then,HPD was increasingly used by more and more clinical centers in an attempt to treat the patients with malignant biliary diseases which cannot be radically resected otherwise.However,owing to the high death rate and incidence rate of complications,most of the centers only reported a few cases,the clinical application of HPD still requires an incessantly accumulation of experience and summarization.Methods:23 cases of hospitalized patient who had been performed with HPD in the First Hospital affiliated to Medical School of Zhejiang University were retrospectively analyzed,23 cases of hospitalized patient who had been performed with a pancreatoduodenectomy(PD)in the corresponding period were randomly drawn by computer,they were included into the case group and control group respectively.The clinical features,postoperative severe abdominal complications,survival prognosis and other results of two groups were compared,the preoperative,intraoperative and postoperative factors that influence the survival of patients in HPD group had been analyzed,and the risk factor of early death after operation of HPD was explored,the single-centric experiences and shortcomings were systemized.Results:The principal surgical indication of HPD group was the patients with biliary tract malignant tumor,while the counterpart of PD group was the patients with pancreatic or duodenal malignant tumor,the former was significantly higher than the latter in terms of tumor marker CA199,CEA,CA125,intraoperative bleeding amount(P<0.05).Kaplan survival analysis showed that the HPD group had a markedly lower postoperative survival than the PD group did(P=0.009).Compared with PD group,the HPD group had a relatively high one-month mortality of 17.4%,and postoperative hospital mortality of 25.2%,while all the deaths were caused by occurrence of severe intra-abdominal complication,including the pancreatic leakage,liver failure and abdominal infection.It was found by single-factor analysis that,the preoperative abdominal symptoms(P=0.023)and reconstruction of portal vein(P=:0.008)were the risk factors for the occurrence of severe intra-abdominal complication in HPD group,wherein,the latter was also a risk factor for postoperative hospital mortality of HPD group during the early stage(P=0.04).To analyze the long-term survival of patients after HPD,we found the risk factors include CA125>35U/mL(P=0.028),reconstruction of portal vein(P=0.01),surgical time>478min(P=0.043),severe intra-abdominal complications(P=0.004),while severe intra-abdominal complications(P=0.018)was an independent risk factor that influences the long-term survival after HPD operation.Conclusion:HPD operation is a high-risk surgical method,which is usually used to treat patients with malignant biliary tumors that cannot be radically resected otherwise.The postoperative survival rate of patients performed with HPD is evidently lower than that of the ones performed with PD.Patients post-HPD operation had a high death rate in early stage,all the deaths are caused by occurrence of severe intra-abdominal complication(including the pancreatic leakage,liver failure and abdominal infection).Abdominal symptoms and reconstruction of portal vein are risk factors of having severe intra-abdominal complication,and the latter is also closely related to postoperative hospital mortality.Meanwhile severe intra-abdominal complication is an independent risk factor that influences the long-term survival after HPD operation.