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| Hepatopancreatoduodenectomy for the treatment of extrahepatic cholangiocarcinoma ? |
| Alberto Porcu a , Giulia Deiana a , Claudio F Feo a , Chiara Ninniri a , Davide Turilli b , Lorena Tanda c , Alessandro Fancellu a ,∗ |
a Department of Clinical, Surgical and Experimental Sciences, Unit of General Surgery 2 - Clinica Chirurgica, University of Sassari, Sassari, Italy
b Unit of Radiological Sciences, AOU Sassari, Sassari, Italy
c Faculty of Medicine and Surgery, University of Sassari, Sassari, Italy
? NOTES: The abstract of this study has been presented, in partial form, at the 123th Congress of the Italian Society of Surgery, held in Catania (Italy) on September 26-29, 2021.
∗ Corresponding author.
E-mail address: afancel@uniss.it (A. Fancellu). |
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Abstract Extrahepatic cholangiocarcinoma (ECC) is an uncommon neoplasm associated with a poor prognosis [1–3]. Surgical resection represents the only curative approach, since systemic treatments have scarce efficacy in achieving disease control. However, only 10%-40% of patients with ECC are resectable at diagnosis [1] . Major hepatectomy and portal lymphadenectomy are usually required for hilar ECC, while pancreatoduodenectomy is the standard operation for distal ECC [3–5]. However, ECC may spread horizontally along the biliary tree, causing tumor involvement of the entire extrahepatic biliary system. In these circumstances, hepatopancreatoduodenectomy (HPD) has been proposed as a procedure with curative intent [2,6,7]. HPD is a complex operation which includes the combination of hepatic resection, pancreatoduodenectomy and extirpation of the extrahepatic biliary system. It has been generally considered a controversial operation, due to the high mortality and morbidity rates in front of uncertain oncological outcomes [5,7-9]. However, in the last 5 years, encouraging survival outcomes, as well as acceptable mortality and morbidity rates, have been reported from surgical teams with high expertise in hepatobiliopancreatic (HBP) surgery [ 2,10,11]. Most literature data focusing on HPD are from Asian institutions, where HPD has been gaining some popularity in the treatment of selected patients with ECC and gallbladder cancer. On the opposite, few reports came from Western countries, where HPD has not been considered a worthwhile, albeit feasible, procedure.
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2023, Vol. 22 
