Cargando…
Hepatopancreatoduodenectomy for advanced biliary malignancies
BACKGROUND: Hepatopancreatoduodenectomy (HPD) has been considered the only curative treatment for metastatic cholangiocarcinoma and some locally advanced gallbladder cancers (GBCs). However, HPD has not yet been included in treatment guidelines as a standard surgical procedure in consideration of it...
Autores principales: | , , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Lippincott Williams & Wilkins
2022
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9943980/ https://www.ncbi.nlm.nih.gov/pubmed/35916551 http://dx.doi.org/10.1097/CM9.0000000000002067 |
_version_ | 1784891818414964736 |
---|---|
author | Wu, Xiangsong Li, Maolan Wu, Wenguang Wang, Xu’an Li, Huaifeng Bao, Runfa Shu, Yijun Shen, Jun Gu, Jun Wang, Xuefeng Gong, Wei Peng, Shuyou Liu, Yingbin |
author_facet | Wu, Xiangsong Li, Maolan Wu, Wenguang Wang, Xu’an Li, Huaifeng Bao, Runfa Shu, Yijun Shen, Jun Gu, Jun Wang, Xuefeng Gong, Wei Peng, Shuyou Liu, Yingbin |
author_sort | Wu, Xiangsong |
collection | PubMed |
description | BACKGROUND: Hepatopancreatoduodenectomy (HPD) has been considered the only curative treatment for metastatic cholangiocarcinoma and some locally advanced gallbladder cancers (GBCs). However, HPD has not yet been included in treatment guidelines as a standard surgical procedure in consideration of its morbidity and mortality rates. The aim of this study was to evaluate the safety and effectiveness of HPD in treating biliary malignancies. METHODS: The medical records of 57 patients with advanced biliary cancer undergoing HPD from January 2009 to December 2019 were retrospectively retrieved. A case-control analysis was conducted at our department. Patients with advanced GBC who underwent HPD (HPD-GBC group) were compared with a control group (None-HPD-GBC group). Baseline characteristics, preoperative treatments, tumor pathologic features, operative results, and prognosis were assessed. RESULTS: Thirteen patients with cholangiocarcinoma and 44 patients with GBC underwent HPD at our department. Significant postoperative complications (grade III or greater) and postoperative pancreatic fistula were observed in 24 (42.1%) and 15 (26.3%) patients, respectively. One postoperative death occurred in the present study. Overall survival (OS) was longer in patients with advanced cholangiocarcinoma than in those with GBC (median survival time [MST], 31 months vs. 11 months; P < 0.001). In the subgroup analysis of patients with advanced GBC, multivariate analysis demonstrated that T4 stage tumors (P = 0.012), N2 tumors (P = 0.001), and positive margin status (P = 0.004) were independently associated with poorer OS. Patients with either one or more prognostic factors exhibited a shorter MST than patients without those prognostic factors (P < 0.001). CONCLUSION: HPD could be performed with a relatively low mortality rate and an acceptable morbidity rate in an experienced high- volume center. For patients with advanced GBC without an N2 or T4 tumor, HPD can be a preferable treatment option. |
format | Online Article Text |
id | pubmed-9943980 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Lippincott Williams & Wilkins |
record_format | MEDLINE/PubMed |
spelling | pubmed-99439802023-02-23 Hepatopancreatoduodenectomy for advanced biliary malignancies Wu, Xiangsong Li, Maolan Wu, Wenguang Wang, Xu’an Li, Huaifeng Bao, Runfa Shu, Yijun Shen, Jun Gu, Jun Wang, Xuefeng Gong, Wei Peng, Shuyou Liu, Yingbin Chin Med J (Engl) Original Articles BACKGROUND: Hepatopancreatoduodenectomy (HPD) has been considered the only curative treatment for metastatic cholangiocarcinoma and some locally advanced gallbladder cancers (GBCs). However, HPD has not yet been included in treatment guidelines as a standard surgical procedure in consideration of its morbidity and mortality rates. The aim of this study was to evaluate the safety and effectiveness of HPD in treating biliary malignancies. METHODS: The medical records of 57 patients with advanced biliary cancer undergoing HPD from January 2009 to December 2019 were retrospectively retrieved. A case-control analysis was conducted at our department. Patients with advanced GBC who underwent HPD (HPD-GBC group) were compared with a control group (None-HPD-GBC group). Baseline characteristics, preoperative treatments, tumor pathologic features, operative results, and prognosis were assessed. RESULTS: Thirteen patients with cholangiocarcinoma and 44 patients with GBC underwent HPD at our department. Significant postoperative complications (grade III or greater) and postoperative pancreatic fistula were observed in 24 (42.1%) and 15 (26.3%) patients, respectively. One postoperative death occurred in the present study. Overall survival (OS) was longer in patients with advanced cholangiocarcinoma than in those with GBC (median survival time [MST], 31 months vs. 11 months; P < 0.001). In the subgroup analysis of patients with advanced GBC, multivariate analysis demonstrated that T4 stage tumors (P = 0.012), N2 tumors (P = 0.001), and positive margin status (P = 0.004) were independently associated with poorer OS. Patients with either one or more prognostic factors exhibited a shorter MST than patients without those prognostic factors (P < 0.001). CONCLUSION: HPD could be performed with a relatively low mortality rate and an acceptable morbidity rate in an experienced high- volume center. For patients with advanced GBC without an N2 or T4 tumor, HPD can be a preferable treatment option. Lippincott Williams & Wilkins 2022-12-05 2022-03-28 /pmc/articles/PMC9943980/ /pubmed/35916551 http://dx.doi.org/10.1097/CM9.0000000000002067 Text en Copyright © 2022 The Chinese Medical Association, produced by Wolters Kluwer, Inc. under the CC-BY-NC-ND license. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) |
spellingShingle | Original Articles Wu, Xiangsong Li, Maolan Wu, Wenguang Wang, Xu’an Li, Huaifeng Bao, Runfa Shu, Yijun Shen, Jun Gu, Jun Wang, Xuefeng Gong, Wei Peng, Shuyou Liu, Yingbin Hepatopancreatoduodenectomy for advanced biliary malignancies |
title | Hepatopancreatoduodenectomy for advanced biliary malignancies |
title_full | Hepatopancreatoduodenectomy for advanced biliary malignancies |
title_fullStr | Hepatopancreatoduodenectomy for advanced biliary malignancies |
title_full_unstemmed | Hepatopancreatoduodenectomy for advanced biliary malignancies |
title_short | Hepatopancreatoduodenectomy for advanced biliary malignancies |
title_sort | hepatopancreatoduodenectomy for advanced biliary malignancies |
topic | Original Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9943980/ https://www.ncbi.nlm.nih.gov/pubmed/35916551 http://dx.doi.org/10.1097/CM9.0000000000002067 |
work_keys_str_mv | AT wuxiangsong hepatopancreatoduodenectomyforadvancedbiliarymalignancies AT limaolan hepatopancreatoduodenectomyforadvancedbiliarymalignancies AT wuwenguang hepatopancreatoduodenectomyforadvancedbiliarymalignancies AT wangxuan hepatopancreatoduodenectomyforadvancedbiliarymalignancies AT lihuaifeng hepatopancreatoduodenectomyforadvancedbiliarymalignancies AT baorunfa hepatopancreatoduodenectomyforadvancedbiliarymalignancies AT shuyijun hepatopancreatoduodenectomyforadvancedbiliarymalignancies AT shenjun hepatopancreatoduodenectomyforadvancedbiliarymalignancies AT gujun hepatopancreatoduodenectomyforadvancedbiliarymalignancies AT wangxuefeng hepatopancreatoduodenectomyforadvancedbiliarymalignancies AT gongwei hepatopancreatoduodenectomyforadvancedbiliarymalignancies AT pengshuyou hepatopancreatoduodenectomyforadvancedbiliarymalignancies AT liuyingbin hepatopancreatoduodenectomyforadvancedbiliarymalignancies |