[Hepatopancreatoduodenectomy (HPD)].

Since the mid-1980s, simultaneous major resection of the liver and the pancreatic head, so-called HPD, has been performed in Japan to improve the survival rate of patients with advanced biliary tract carcinoma. We conducted a study of HPD in dogs in our laboratory from 1986 to 1989 and found that 75% died following 70% hepatectomy with more than 92% pancreatectomy and that only 25% survived. The main cause of death was liver failure. A clinical review of the operative procedures and the outcome of HPD was performed by Mizumoto et al. in our department in 1989. They collected data on 241 patients who underwent HPD for advanced biliary tract carcinoma throughout Japan. The postoperative morbidity and mortality rates after HPD were higher than after other major surgeries. The prognosis after HPD has improved in recent years because of preservation of adequate hepatic or pancreatic parenchyma, improvements in surgical technique, and strict perioperative care. Therefore we plan to review the operative procedures and outcome of HPD again in 2000.