Department of Gastrointestinal Surgery, Aichi Cancer Center Hospital, Nagoya, Japan.
Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
J Hepatobiliary Pancreat Sci. 2021 Apr;28(4):376-386. doi: 10.1002/jhbp.914. Epub 2021 Mar 12.
Only a few authors have reported negative results for hepatopancreatoduodenectomy (HPD) with simultaneous resection of the portal vein and hepatic artery in a limited number of patients. The aim of the current study was to outline our experience with this superextended surgery and to discuss its clinical value.
Medical records of consecutive patients who underwent resection of perihilar cholangiocarcinoma between 2007 and 2020 were retrospectively reviewed.
During the study interval, 650 patients with perihilar cholangiocarcinoma underwent resection. The superextended surgery was performed in only nine (1.4%) patients. Left or right trisectionectomy was primarily performed. For portal vein reconstruction, external iliac vein graft was required in seven patients. For hepatic artery reconstruction, rotating left gastric artery was often used. The median operative time was 870 minutes and blood loss was 2,598 mL. Postoperatively, pancreatic fistula and liver failure occurred in all patients, followed by intraabdominal abscess (n = 8), and bacteremia (n = 4). One patient died on day 86 due to multiple organ failure. Two patients survived for more than 7 years.
HPD with simultaneous resection of the portal vein and hepatic artery is demanding but worth performing as the last option, with careful patient selection in experienced centers.
仅有少数作者报道了少数患者行肝胰十二指肠切除术（HPD）联合门静脉和肝动脉切除的阴性结果。本研究旨在总结我们对此超扩大手术的经验并探讨其临床价值。
回顾性分析 2007 年至 2020 年间连续接受肝门部胆管癌切除术的患者的病历。
研究期间，650 例肝门部胆管癌患者接受了切除术。仅 9 例（1.4%）患者行超扩大手术。主要行左或右三叶切除术。7 例患者需要行髂外静脉移植重建门静脉，旋转胃左动脉常用于肝动脉重建。中位手术时间为 870 分钟，出血量为 2598 毫升。术后所有患者均发生胰瘘和肝功能衰竭，随后发生腹腔脓肿（n=8）和菌血症（n=4）。1 例患者因多器官功能衰竭于术后 86 天死亡。2 例患者存活超过 7 年。
HPD 联合门静脉和肝动脉切除具有挑战性，但作为最后的选择是值得的，在有经验的中心应谨慎选择患者。
