Back to Search
Start Over
Extended liver surgery for gallbladder cancer revisited: Is there a role for hepatopancreatoduodenectomy?
- Source :
- International Journal of Surgery. 82:82-86
- Publication Year :
- 2020
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2020.
-
Abstract
- Gallbladder cancer (GBCA) is a rare and fatal disease and the majority of patients presents with advanced stage. Surgical resection associated with lymphadenectomy is the only chance for cure. For patients in stages III and IV, extended resection is the only treatment to achieve R0 margins. For GBCA invading the hepatoduodenal ligament and pancreatoduodenal region, the resection of extrahepatic bile duct and pancreas is necessary. Hepatopancreatoduodenectomy (HPD) represents the most complex and challenging procedure in the hepatopancreatobiliary region. Kuno at the Cancer Institute Hospital Tokyo performed the first HPD in Japan in 1974 and in 1980 Takasaki presented five cases and the 30-day mortality was 60%. After that, other countries started to perform the procedure including United States and Brazil. The main complications are liver failure and pancreatic fistula. Advancements in perioperative care, surgical technique, medical instruments and postoperative at intensive care unit have resulted in reduction in morbidity and mortality. The use of portal vein embolization is indicated to increase the liver volume in patients with insufficient remnant. Preoperative biliary drainage can prevent cholangitis and improve hepatic function. This procedure should be recommended before extended HPD in jaundiced patients. Operative results with mortality rates below 5% at high volume centers suggest that HPD should be performed at centers with expertise in hepatopancreatobiliary surgery.
- Subjects :
- Male
medicine.medical_specialty
medicine.medical_treatment
030230 surgery
Pancreaticoduodenectomy
law.invention
03 medical and health sciences
0302 clinical medicine
Japan
Bile Ducts, Extrahepatic
law
medicine
Hepatectomy
Humans
Gallbladder cancer
Pancreas
Aged
Bile duct
business.industry
Mortality rate
Cancer
Hepatoduodenal ligament
General Medicine
Middle Aged
medicine.disease
Intensive care unit
Surgery
medicine.anatomical_structure
Liver
Pancreatic fistula
030220 oncology & carcinogenesis
Female
Gallbladder Neoplasms
Lymphadenectomy
business
Subjects
Details
- ISSN :
- 17439191
- Volume :
- 82
- Database :
- OpenAIRE
- Journal :
- International Journal of Surgery
- Accession number :
- edsair.doi.dedup.....4dc0fab67101294cfcb3de1bb1d65c42