Current role of hepatopancreatoduodenectomy for the management of gallbladder cancer and extrahepatic cholangiocarcinoma: A systematic review

Abstract

BACKGROUND Hepatopancreatoduodenectomy (HPD) is the simultaneous combination of hepatic resection, pancreaticoduodenectomy, and resection of the entire extrahepatic biliary system. HPD is not a universally accepted due to high mortality and morbidity rates, as well as to controversial survival benefits. AIM To evaluate the current role of HPD for curative treatment of gallbladder cancer (GC) or extrahepatic cholangiocarcinoma (ECC) invading both the hepatic hilum and the intrapancreatic common bile duct. METHODS A systematic literature search using the PubMed, Web of Science, and Scopus databases was performed to identify studies reporting on HPD, using the following keywords: ‘Hepatopancreaticoduodenectomy’, ‘hepatopancreatoduodenectomy’, ‘hepatopancreatectomy’, ‘pancreaticoduodenectomy’, ‘hepatectomy’, ‘hepatic resection’, ‘liver resection’, ‘Whipple procedure’, ‘bile duct cancer’, ‘gallbladder cancer’, and ‘cholangiocarcinoma’. RESULTS This updated systematic review, focusing on 13 papers published between 2015 and 2020, found that rates of morbidity for HPD have remained high, ranging between 37.0% and 97.4%, while liver failure and pancreatic fistula are the most serious complications. However, perioperative mortality for HPD has decreased compared to initial experiences, and varies between 0% and 26%, although in selected center it is well below 10%. Long term survival outcomes can be achieved in selected patients with R0 resection, although 5–year survival is better for ECC than GC. CONCLUSION The present review supports the role of HPD in patients with GC and ECC with horizontal spread involving the hepatic hilum and the intrapancreatic bile duct, provided that it is performed in centers with high experience in hepatobiliary-pancreatic surgery. Extensive use of preoperative portal vein embolization, and preoperative biliary drainage in patients with obstructive jaundice, represent strategies for decreasing the occurrence and severity of postoperative complications. It is advisable to develop internationally-accepted protocols for patient selection, preoperative assessment, operative technique, and perioperative care, in order to better define which patients would benefit from HPD.

Surgical outcomes of gallbladder cancer: the OMEGA retrospective, multicentre, international cohort study

“…The greater likelihood of nodal and margin involvement and micrometastatic spread at higher disease stages may therefore obviate any benefit from liver resection at higher tumour stages, corroborating similar findings from other studies. 13 , 23 These data should not be interpreted to suggest that cholecystectomy alone should be considered sufficient treatment for these higher stages of disease, but rather that these patients may benefit more from neoadjuvant chemotherapy rather than upfront surgery.…”

“… 7 , 8 , 9 Indeed, studies indicate that many hepatopancreatobiliary (HPB) surgeons globally are more likely to adopt aggressive surgical options for locally advanced GBC than follow published consensus guidelines recommending systemic treatment, including a recent survey wherein over 30% stated they would routinely perform major hepatectomy or extrahepatic bile duct resection (EBDR) for higher stage tumours. 10 , 11 , 12 , 13 , 14 The morbidity of these operations for patients is considerable, as well as the additional cost to healthcare systems, and any additional survival benefit is poorly-defined. 13 …”

“… 10 , 11 , 12 , 13 , 14 The morbidity of these operations for patients is considerable, as well as the additional cost to healthcare systems, and any additional survival benefit is poorly-defined. 13 …”

Liver transplantation in the management of cholangiocarcinoma: Evolution and contemporary advances

“…Attempts at hepatopancreatoduodenectomy for these patients have been technically challenging with high rates of perioperative morbidity and mortality at up to 97.4% and 26% respectively in recent series. Five-year OS has ranged from 17.9%-49.2%[ 58 ]. Total hepatectomy, LT and pancreatoduodenectomy may have potential to be a better alternative therapy in this population.…”

Laparoscopic hepatopancreaticoduodenectomy for synchronous gallbladder cancer and extrahepatic cholangiocarcinoma: a case report

“…Almost half a century passed, this procedure was not universally accepted. In total, no more than 1000 HPDs have been reported [ 2 , 3 ] for the past 50 years because of the high morbidity and mortality [ 4 – 6 ]. After a comprehensive search of PubMed using the terms of laparoscopy, hepatopancreaticoduodenectomy, hepatopancreatoduodenectomy, hepatopancreatectomy, pancreaticoduodenectomy, and hepatectomy, there were only 3 reports [ 7 – 9 ] involving 3 laparoscopic HPDs (LHPD) for locally advanced GBC or extrahepatic cholangiocarcinoma (ECC) which were list in detail in Table 1 .…”