Top

World Journal of Surgery

Published in:

01-11-2010

Survival Benefit of Hepatopancreatoduodenectomy for Cholangiocarcinoma in Comparison to Hepatectomy or Pancreatoduodenectomy

Authors: Yuji Kaneoka, Akihiro Yamaguchi, Masatoshi Isogai, Takashi Kumada

Published in: World Journal of Surgery | Issue 11/2010

Abstract

Background

Perihilar and distal cholangiocarcinoma remain difficult to treat, and long-term survival is poor. We conducted a retrospective study of patients with cholangiocarcinoma to examine whether hepatopancreatoduodenectomy, in comparison to standard surgeries, provides a survival benefit.

Methods

Subjects were 75 patients with perihilar or distal cholangiocarcinoma who, between April 1997 and May 2007, underwent hepatectomy with bile duct resection (Hx, n = 29), pancreatoduodenectomy (PD, n = 32), or hepatopancreatoduodenectomy (HPD, n = 14) at our hospital. We compared surgical outcomes and survival between groups and identified factors negatively influencing survival.

Results

Morbidity and in-hospital mortality did not differ significantly between groups (Hx group, 34% and 10%, respectively; PD group, 44% and 3%; and HPD, 57% and 0%). The overall median survival time was 39 months, and overall 5-year survival (including in-hospital mortality) was 42%. Respective group values were as follows: Hx, 24 months and 31%; PD, 51 months and 49%, and HPD, 63 months and 50%. Although the number of patients was small, survival in the HPD was not influenced by the type of invasion whether widespread intramural invasion (n = 8), superficial spread (n = 4), or hepatoduodenal ligament invasion (n = 2). Multivariate analysis (Cox proportional hazards model) showed only perineural invasion (p = .007) and decreased curability (R1/2 resection) (p = .017) to be independent risk factors influencing survival.

Conclusions

In cases of perihilar or distal cholangiocarcinoma, aggressive surgery must be aimed at overcoming perineural invasion. Our findings indicate that HPD improves survival of patients undergoing surgery for widespread cholangiocarcinoma in comparison to standard surgeries.

Burke EC, Jarnagin WR, Hochwald SN et al (1998) Hilar cholangiocarcinoma: patterns of spread, the importance of hepatic resection for curative operation, and a presurgical clinical staging system. Ann Surg 228:385–394CrossRefPubMed

Jarnagin WR, Fong Y, DeMatteo RP et al (2001) Staging, resectability, and outcome in 225 patients with hilar cholangiocarcinoma. Ann Surg 234:507–519CrossRefPubMed

Kondo S, Hirano S, Ambo Y et al (2004) Forty consecutive resections of hilar cholangiocarcinoma with no postoperative mortality and no positive ductal margins: results of a prospective study. Ann Surg 240:95–101CrossRefPubMed

Ikeyama T, Nagino M, Oda K et al (2007) Surgical approach to Bismuth type I and II hilar cholangiocarcinomas: audit of 54 consecutive cases. Ann Surg 246:1052–1057CrossRefPubMed

Yeo CJ, Sohn TA, Cameron JL et al (1998) Periampullary adnocarcinoma: analysis of 5-year survivors. Ann Surg 227:821–831CrossRefPubMed

Sakamoto Y, Kosuge T, Shimada K et al (2005) Prognostic factors of surgical resection in middle and distal bile duct cancer: an analysis of 55 patients concerning the significance of ductal and radical margins. Surgery 137:396–402CrossRefPubMed

Takasaki K, Kobayashi S, Muto H et al (1980) Our experience (5 cases) of extended right lobectomy combined with pancreatoduodenectomy for the carcinoma of the gallbladder. Tan To Sui 7:923–932 (in Japanese)

Nimura Y, Hayakawa N, Kamiya J et al (1991) Hepatopancreatoduodenectomy for advanced carcinoma of the biliary tract. Hepatogastroenterology 38:170–175PubMed

Tsukada K, Yoshida K, Aono T et al (1994) Major hepatectomy and pancreatoduodenectomy for advanced carcinoma of the biliary tract. Br J Surg 81:108–110CrossRefPubMed

10.

Hanyu F, Nakamura M, Yoshikawa T (1998) Hepato-ligamento-pancreatoduodenectomy (in Japanese). Gekachiryo (Surg Ther) 59:12–21

11.

Nagino M, Nimura Y, Kamiya J et al (1996) Selective percutaneous transhepatic embolization of the portal vein in preparation for extensive liver resection: the ipsilateral approach. Radiology 200:559–563PubMed

12.

Sobin HL, Wittekind C (2002) TNM classification of malignant tumors, 6th edn. Wiley-Liss, New York

13.

Ebata T, Kamiya J, Nishio H et al (2009) The concept of perihilar cholangiocarcinoma is valid. Br J Surg 96:926–934CrossRefPubMed

14.

Bassi C, Dervenis C, Butturini G et al (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138:8–13CrossRefPubMed

15.

Wente MN, Bassi C, Dervenis C et al (2007) Delayed gastric empting (DGE) after pancreatic surgery: a suggested definition by the international study group of pancreatic surgery (ISGPS). Surgery 142:761–768CrossRefPubMed

16.

Japanese Society of Biliary Surgery (2003) General rules for surgical and pathological studies on cancer of the biliary tract, 5th edn. Kanehara Shuppan, Tokyo, pp 60–61 (in Japanese)

17.

Kaneoka Y, Yamaguchi A, Isogai M et al (2003) Hepatoduodenal ligament invasion by gallbladder carcinoma: histologic patterns and surgical recommendation. World J Surg 27:260–265CrossRefPubMed

18.

Kaneoka Y, Yamaguchi A, Isogai M (2007) Hepatopancreatoduodenectomy: its suitability for bile duct cancer versus gallbladder cancer. J Hepatobiliary Pancreat Surg 14:142–148CrossRefPubMed

19.

Miyagawa S, Makuuchi M, Kawasaki S et al (1996) Outcome of major hepatectomy with pancreatoduodenectomy for advanced biliary malignancies. World J Surg 20:77–80CrossRefPubMed

20.

Ebata T, Nagino M, Nishio H et al (2007) Right hepatopancreatoduodenectomy: improvements over 23 years to attain acceptability. J Hepatobiliary Pancreat Surg 14:131–135CrossRefPubMed

21.

Ishihara S, Miyakawa S, Takada T et al (2007) Status of surgical treatment of biliary tract cancer. Dig Surg 24:131–136CrossRefPubMed

22.

Kawasaki S, Makuuchi M, Miyagawa S et al (1994) Radical operation after portal embolization for tumor of hilar bile duct. J Am Coll Surg 178:480–486PubMed

23.

Kawasaki S, Imamura H, Kobayashi A et al (2003) Results of surgical resection for patients with hilar bile duct cancer: application of extended hepatectomy after biliary drainage and hemihepatic portal vein embolization. Ann Surg 238:84–92CrossRefPubMed

24.

Seyama Y, Kubota K, Sano K et al (2003) Long-term outcome of extended hemihepatectomy for hilar bile duct cancer with no mortality and high survival rate. Ann Surg 238:73–83CrossRefPubMed

25.

Nagino M, Kamiya J, Nishio H et al (2006) Two hundred forty consecutive portal vein embolizations before extended hepatectomy for biliary cancer: surgical outcome and long-term follow-up. Ann Surg 243:364–372CrossRefPubMed

26.

Makuuchi M, Thai BL, Takayasu K et al (1990) Preoperative portal embolization to increase safety of major hepatectomy for hilar bile duct carcinoma: a preliminary report. Surgery 107:521–527PubMed

27.

Nagino M, Nimura Y, Kamiya J et al (1995) Changes in hepatic lobe volume in biliary tract cancer patients after right portal vein embolization. Hepatology 21:434–439PubMed

28.

Seyama Y, Makuuchi M (2007) Current surgical treatment for bile duct cancer. World J Gastroenterol 13:1505–1515PubMed

29.

Yoshimi F, Asato Y, Amemiya R et al (2001) Comparison between pancreatoduodenectomy and hepatopancreatoduodenectomy for bile duct cancer. Hepatogastroenterology 48:994–998PubMed

30.

Miyagawa S, Makuuchi M, Kawasaki S et al (1994) Second-stage pancreatojejunostomy following pancreatoduodenectomy in high-risk patients. Am J Surg 168:66–68CrossRefPubMed

31.

Neuhaus P, Jonas S, Bechsein WO et al (1999) Extended resections for hilar cholangiocarcinoma. Ann Surg 230:808–819CrossRefPubMed

32.

Ebata T, Nagino M, Kamiya J et al (2003) Hepatectomy with portal vein resection for hilar cholangiocarcinoma: audit of 52 consecutive cases. Ann Surg 238:720–727CrossRefPubMed

33.

Nimura Y, Kamiya J, Kondo S et al (2000) Aggressive preoperative management and extended surgery for hilar cholangiocarcinoma: Nagoya experience. J Hepatobiliary Pancreat Surg 7:155–162CrossRefPubMed

34.

Sakamoto Y, Shimada K, Nara S et al (2010) Surgical management of infrahilar/suprapancreatic cholangiocarcinoma: an analysis of the surgical procedures, surgical margins, and survivals of 77 patients. J Gastrointest Surg 14:335–343CrossRefPubMed

35.

Miyazaki M, Kato A, Ito H et al (2007) Combined vascular resection in operative resection for hilar cholangiocarcinoma: does it work or not? Surgery 141:581–588CrossRefPubMed

36.

Nakamura S, Suzuki S, Serizawa A et al (1996) Hepatopancreatoduodenectomy for superficially spreading bile duct carcinoma: a report of two 5 year survivals. Hepatogastroenterology 43:138–142PubMed

37.

Miwa S, Kobayashi A, Akahane Y et al (2007) Is major hepatectomy with pancreatoduodenectomy justified for advanced biliary malignancy? J Hepatobiliary Pancreat Surg 14:136–141CrossRefPubMed

38.

Kaneoka Y, Yamaguchi A, Isogai M et al (2003) Longer than 3-year survival following hepato-ligamento-pancreatoduodenectomy for hilar cholangiocarcinoma with vascular involvement: report of a case. Surg Today 33:772–776CrossRefPubMed

39.

Klempnauer J, Ridder GJ, Werner M et al (1997) What constitutes long term survival after surgery for hilar cholangiocarcinoma? Cancer 79:26–34CrossRefPubMed

40.

DeOliveira ML, Cunningham SC, Cameron JL et al (2007) Cholangiocarcinoma: thirty-one-year experience with 564 patients at a single institution. Ann Surg 245:755–762CrossRefPubMed

41.

Bhuiya MR, Nimura Y, Kamiya J et al (1992) Clinicopathological studies on perineural invasion of bile duct carcinoma. Ann Surg 215:344–349CrossRefPubMed

42.

Ogura Y, Takahashi K, Tabata M et al (1994) Clinicopathological study on carcinoma of the extrahepatic bile duct with special focus on cancer invasion on the surgical margins. World J Surg 18:778–784CrossRefPubMed

Title: Survival Benefit of Hepatopancreatoduodenectomy for Cholangiocarcinoma in Comparison to Hepatectomy or Pancreatoduodenectomy
Authors: Yuji Kaneoka
Akihiro Yamaguchi
Masatoshi Isogai
Takashi Kumada
Publication date: 01-11-2010
Publisher: Springer-Verlag
Published in: World Journal of Surgery / Issue 11/2010
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-010-0702-2

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Survival Benefit of Hepatopancreatoduodenectomy for Cholangiocarcinoma in Comparison to Hepatectomy or Pancreatoduodenectomy

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 11/2010

Lymph Node Involvement and Surgical Approach in Parathyroid Cancer

Hospitalization, Frequency of Interventions, and Quality of Life after Endoscopic, Surgical, or Conservative Treatment in Patients with Chronic Pancreatitis

Foley Catheter Enterostomy for Postoperative Bowel Perforation: An Effective Source Control

Molecular Testing for Somatic Mutations Improves the Accuracy of Thyroid Fine-needle Aspiration Biopsy

Challenges in Developing New Biomarkers for Breast Cancer

Vascular Reconstruction During Pancreatoduodenectomy for Ductal Adenocarcinoma of the Pancreas Improves Resectability but does not Achieve Cure