Hepatoligamentopancreatoduodenectomy in Patients with Advanced Gallbladder Carcinoma

Yoshikawa, Takahiro; Araida, Tatsuo; Nakamura, Mitsuji; Azuma, Tsukasa; Oota, Takehiro; Takasaki, Ken; Hanyu, Fujio

doi:10.1007/978-4-431-68541-8_20

Cited by 4 publications

(12 citation statements)

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“…A nationwide survey by Nakamura11 in 1991 reported that ligamentectomy had been performed in 24 cases, quite an increase in number of recent cases so treated. However, the incidence of postoperative complications resulting in hospital death was very high as in previous reports ,. For this reason, HLPD and ligamentectomy have not yet been approved as standard surgical procedures, there is not inconsiderable doubt within the profession.…”

Section: Discussionmentioning

confidence: 46%

“…It has been histopathologically proven that advanced biliary tract carcinomas often develop rapidly along the hepatic Glisson's sheath and hepatoduodenal ligament 6,. If major vessels in a carcinomatous hepatoduodenal ligament are to be conserved, there should be some limitation on the dissection of lymph nodes and nerves.…”

Section: Discussionmentioning

confidence: 99%

“…The most frequent cause of early postoperative death in HLPD and ligamentectomy is complications arising from the obstruction of the reconstructed hepatic artery 6,16,17. Nakamura11 reported that when both the hepatic artery and portal vein were resected in HPD, the incidence of early postoperative complications and following hospital deaths was 86.8% and 68.4%, respectively, and that these incidences were far higher than in cases where only the portal vein was resected.…”

Section: Discussionmentioning

confidence: 99%

“…For this reason, ultimate radical resection, such as hepatopancreatoduodenectomy (HPD) and hepatoligamentopancreatoduodenectomy (HLPD), are being challenged . However, resectability and curability are now increasing and long‐term survival has been reported in some cases . The most serious problem of such procedures is a high incidence of postoperative complications, with hospital death observed quite often ,.…”

Section: Introductionmentioning

confidence: 99%

“…However, resectability and curability are now increasing and long‐term survival has been reported in some cases . The most serious problem of such procedures is a high incidence of postoperative complications, with hospital death observed quite often ,. The results of hepatoduodenal ligamentectomy (HLPD) are even worse, because of risk factors such as total hepatic ischemia during resection and reconstruction of the portal vein and hepatic artery, and low patency of the reconstructed hepatic artery.…”

Section: Introductionmentioning

confidence: 99%

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Modified hepatoduodenal ligamentectomy for advanced carcinoma of the biliary tract: The importance of preservation of the replaced left hepatic artery

Mizutani

Maeta

Wakabayashi

et al. 1998

Journal of Hepato-Biliary-Pancreatic Surgery

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Hepatoduodenal ligamentectomy (ligamentectomy) is the ultimate surgery for biliary tract carcinoma involving perioperative difficulties such as total hepatic ischemia during revascularization of the hepatic artery and the portal vein, patency of the reconstructed hepatic artery, and high incidence of related operative mortality. In the present study, modified ligamentectomies with extended right hepatic lobectomy, including resection of the caudate lobe, were performed on three patients with advanced biliary tract carcinoma in whom the left hepatic artery had been replaced and the original artery was preserved. In all patients, postoperative courses were uneventful: success of the resection was confirmed by histological examination. This procedure enabled en bloc resection of hepatoduodenal ligament with positive cancer invasion to take place. It was carried out safely without concern for the difficulties described above. In our view, ligamentectomy should be performed in all such cases.

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Section: Discussionmentioning

confidence: 46%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Modified hepatoduodenal ligamentectomy for advanced carcinoma of the biliary tract: The importance of preservation of the replaced left hepatic artery

Mizutani

Maeta

Wakabayashi

et al. 1998

Journal of Hepato-Biliary-Pancreatic Surgery

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Hepatopancreatoduodenectomy with simultaneous resection of the portal vein and hepatic artery for locally advanced cholangiocarcinoma: Short‐ and long‐term outcomes of superextended surgery

Nagino

Yokoyama

Igami

et al. 2021

J Hepato Biliary Pancreat

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Background Only a few authors have reported negative results for hepatopancreatoduodenectomy (HPD) with simultaneous resection of the portal vein and hepatic artery in a limited number of patients. The aim of the current study was to outline our experience with this superextended surgery and to discuss its clinical value. Methods Medical records of consecutive patients who underwent resection of perihilar cholangiocarcinoma between 2007 and 2020 were retrospectively reviewed. Results During the study interval, 650 patients with perihilar cholangiocarcinoma underwent resection. The superextended surgery was performed in only nine (1.4%) patients. Left or right trisectionectomy was primarily performed. For portal vein reconstruction, external iliac vein graft was required in seven patients. For hepatic artery reconstruction, rotating left gastric artery was often used. The median operative time was 870 minutes and blood loss was 2,598 mL. Postoperatively, pancreatic fistula and liver failure occurred in all patients, followed by intraabdominal abscess (n = 8), and bacteremia (n = 4). One patient died on day 86 due to multiple organ failure. Two patients survived for more than 7 years. Conclusions HPD with simultaneous resection of the portal vein and hepatic artery is demanding but worth performing as the last option, with careful patient selection in experienced centers.

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Operative outcome and problems of right hepatic lobectomy with pancreatoduodenectomy for advanced carcinoma of the biliary tract

Ota

Araida

Yamamoto

et al. 2007

J Hepatobiliary Pancreat Surg

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From 1979 to 1996, 32 patients underwent at least right hepatic lobectomy with pancreatoduodenectomy (right HPD) for advanced carcinoma of the biliary tract at our institute. Twelve of the 32 patients underwent hepatoligamentopancreatoduodenectomy (HLPD). Curative resection was achieved in 20 (63%) of the 32 patients, but the operative outcomes were not satisfactory. Operative deaths occurred in 15 (47%) of the 32 patients, and postoperative complications in 29 (91%). The overall cumulative 1-, 3-, and 5-year survival rates were 12%, 6%, and 3%, respectively. These results suggested that simultaneous hepatectomy of the right lobe and pancreatoduodenectomy is undesirable, especially when accompanied by vascular resection and reconstruction. Since 1997, we have used partial pancreatectomy and partial duodenectomy instead of pancreatoduodenectomy for access to peripancreatic lesions, and this has markedly improved the operative outcome. From 1997 to 2004, 42 patients underwent resection of the right hepatic lobe, extrahepatic bile duct, and other related organs for advanced carcinoma of the biliary tract. There were postoperative complications in 13 (31%), but no operative death occurred. Recent advances in operative procedures and perioperative management may offer greater safety for right HPD, but the appropriate applications of and the necessity for right HPD are still matters of controversy and require further discussion.

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Hepatoligamentopancreatoduodenectomy in Patients with Advanced Gallbladder Carcinoma

Cited by 4 publications

References 0 publications

Modified hepatoduodenal ligamentectomy for advanced carcinoma of the biliary tract: The importance of preservation of the replaced left hepatic artery

Modified hepatoduodenal ligamentectomy for advanced carcinoma of the biliary tract: The importance of preservation of the replaced left hepatic artery

Hepatopancreatoduodenectomy with simultaneous resection of the portal vein and hepatic artery for locally advanced cholangiocarcinoma: Short‐ and long‐term outcomes of superextended surgery

Operative outcome and problems of right hepatic lobectomy with pancreatoduodenectomy for advanced carcinoma of the biliary tract

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