演題

Surgical results of hepatopancreatoduodenectomy for perihilar cholangiocarcinoma: Shizuoka experience

[演者] Takaaki Ito:1
[著者] Teiichi Sugiura:1, Yukiyasu Okamura:1, Yusuke Yamamoto:1, Yusuke Kinugasa:2, Etsuro Bando:2, Masanori Terashima:2, Katsuhiko Uesaka:1
1:Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center Hospital, 2:Department of Gastroenterological Surgery, Shizuoka Cancer Center Hospital

【Background】Although hepatopancreatoduodenectomy (HPD) is mandatory to achieve R0 resection for perihilar cholangiocarcinoma (PCC) with distal extension, it has been a challenging procedure associated with high morbidity and mortality rates.【Methods】From 2002 to 2013, consecutive 157 patients with PCC underwent major hepatectomy with caudate lobectomy at Shizuoka Cancer Center Hospital. Of them, HPD was performed in 41 patients, including combined vascular resection (hepatic artery or/and portal vein) in 15 patients. Surgical results and long-term outcome after HPD were investigated retrospectively. 【Results】The median operating time was 729 minutes and blood loss was 1926mL. There was one mortality case (mortality rate 2%). The morbidity rate (Clavien-Dindo≧3a) was 73%; pancreatic fistula was the most common abdominal complication (n=25), followed by intra-abdominal abscess (n=7), ascites (n=7), wound infection (n=6), bile leakage (n=3), bleeding (n=3), delayed gastric emptying (n=2) and portal vein thrombosis (n=1). There was no patient with serum bilirubin level of more than 10mg/dL after surgery. Relaparotomy was necessary in three patients (7%). Overall survival for 37 HPD patients with M0 disease who survived surgery was comparable to that for 109 patients without pancreatoduodenectomy: The 3- and 5-year survival rates and median survival time were 59%, 45%, and 57 months in HPD patients, and 73%, 51%, and 79 months in patients without pancreatoduodenectomy, respectively (p=0.257).【Conclusion】Although HPD for PCC with downward extension was associated with a high morbidity rate, it could bring a favorable long-term survival after surgery with an acceptable mortality rate.
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