Hepatopancreatoduodenectomy-Lesson’s with 35 Patients over 10 Years

Abstract

AimHepatopancreatoduodenectomy (HPD) is the most complex abdominal surgery and performed in only a few groups in Brazil. Gallbladder cancer remains a reserved prognosis disease and in selected cases, radical resection (R0) surgery allows survival even in advanced tumors. Cholangiocarcinomas represent the main indication for HPD with promising results. IntroductionHepatopancreatoduodenectomy (HPD) represents the most complex abdominal operation comprising generally large resections of hepatic parenchyma combined with gastro-duodenum-pancreatectomy, in which its main indications include biliary tract neoplasia. Surgical resection is considered the only potential modality of cure in the treatment of malignant biliary tumors, including gallbladder cancer and cholangiocarcinomas. High morbidity and mortality rates still affect a large part of the patients submitted to this operation due to extensive resections of hepatic parenchyma associated with critical anastomoses of bile ducts and pancreatic gland. 1-3Biliary carcinoma can be divided between gallbladder carcinoma and cholangiocarcinomas, since they have distinct biological behavior, probably because they have very different histological characteristics. Gallbladder carcinoma often mimics "pseudoklatskin" hilar cholangiocarcinomas. The rich submucosal layer of the gallbladder is connected to the large lymphatic chain of the hepatic and retroperitoneum wire, in addition to numerous cystic veins draining into the liver parenchyma. In this way, the carcinoma of the vesicle presents a more aggressive biological behavior, with distant metastatic potential. In contrast, cholangiocarcinomas present local and radial (superficial spread) infiltration and less frequent distant dissemination, probably due to their histology with scarce submucosal layer. Abstract Hepatopancreatoduodenectomy (HPD) represents the most complex abdominal operation comprising generally large resections of hepatic parenchyma combined with gastro-duodenum-pancreatectomy, in which its main indications include biliary tract neoplasia. Surgical resection is considered the only potential modality of cure in the treatment of malignant biliary tumors, including gallbladder cancer and cholangiocarcinomas. High morbidity and mortality rates still affect a large part of the patients submitted to this operation due to extensive resections of hepatic parenchyma associated with critical anastomoses of bile ducts and pancreatic gland.