Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Surgery. 2013 Jun;153(6):794-800. doi: 10.1016/j.surg.2012.11.024. Epub 2013 Feb 13.
Major hepatopancreaticoduodenectomy (HPD) is an extensive surgical procedure offering the highest curability for patients with advanced biliary cancer. However, surgical morbidity associated with major HPD is high, and optimal indications for this procedure remain unclear.
Between 1989 and 2010, 14 patients with widespread bile duct cancer and 5 with gallbladder cancer having biliary infiltration underwent major HPD at our hospital. Preoperative portal vein embolization was performed in 17 patients undergoing right HPD. Clinicopathologic factors and survivals following HPD were compared between patients with bile duct cancer and those with gallbladder cancer.
One patient who underwent right HPD for gallbladder cancer died of hepatic failure (5.3%) and 18 of the 19 patients (95%) developed postoperative pancreatic fistulas. The median hospital stay was 47 days. Depth of invasion was T3 in 1 patient and T4 in 2 patients with bile duct cancer and was T4 in all 5 patients with gallbladder cancer (P = .002). The clinical stage was IV in 3 patients (21%) with bile duct cancer and in all 5 patients with gallbladder cancer (P = .002). The 5-year survival rates and median survival rates of patients with bile duct cancer and gallbladder cancer were 45% vs 0 and 3.3 years vs 8 months, respectively (P < .001).
HPD can be an acceptable treatment option for widespread bile duct cancer. However, the indication for HPD in advanced-stage gallbladder cancer should be considered carefully, considering the high morbidity rate and the advanced stage of the disease.
大肝胰十二指肠切除术（HPD）是一种广泛的外科手术，可为晚期胆道癌患者提供最高的治愈率。然而，与大 HPD 相关的手术发病率较高，并且该手术的最佳适应证尚不清楚。
1989 年至 2010 年，我院收治 14 例广泛胆管癌和 5 例胆囊癌伴胆管浸润患者行大 HPD。17 例行右 HPD 的患者术前行门静脉栓塞术。比较胆管癌和胆囊癌患者的 HPD 后临床病理因素和生存率。
1 例胆囊癌行右 HPD 的患者死于肝功能衰竭（5.3%），19 例患者中有 18 例（95%）发生术后胰瘘。中位住院时间为 47 天。胆管癌患者中浸润深度 T3 为 1 例，T4 为 2 例，胆囊癌患者均为 T4（P =.002）。胆管癌患者中临床分期为 IV 期的有 3 例（21%），胆囊癌患者均为 5 例（P =.002）。胆管癌和胆囊癌患者的 5 年生存率和中位生存时间分别为 45% vs 0 和 3.3 年 vs 8 个月（P <.001）。
HPD 可作为广泛胆管癌的一种可接受的治疗选择。然而，对于晚期胆囊癌患者，应考虑到高发病率和疾病的晚期阶段，谨慎考虑 HPD 的适应证。
