Mortality, morbidity, and failure to rescue in hepatopancreatoduodenectomy: An analysis of patients registered in the National Clinical Database in Japan

Abstract

Background The high operative mortality rate after hepatopancreatoduodenectomy (HPD) is still a major issue. The present study explored why operative mortality differs significantly due to hospital volume. Method Surgical case data were extracted from the National Clinical Database (NCD) in Japan from 2011 to 2014. Surgical procedures were categorized as major (≥2 sections) and minor (<2 sections) hepatectomy. Hospitals were categorized according to the certification system by the Japanese Society of Hepato‐Biliary‐Pancreatic Surgery (JSHBPS) based on the number of major hepato‐biliary‐pancreatic surgeries performed per year. The FTR rate was defined as death in a patient with at least one postoperative complication. Results A total of 422 patients who underwent HPD were analyzed. The operative mortality rates in board‐certified A training institutions, board‐certified B training institutions, and non‐certified institution were 7.2%, 11.6%, and 21.4%, respectively. Multiple logistic regression showed that certified A institutions, major hepatectomy, and blood transfusion were the predictors of operative mortality. Failure to rescue rates were lowest in certified A institutions (9.3%, 17.0%, and 33.3% in certified A, certified B, and non‐certified, respectively). Conclusions To reduce operative mortality after HPD, further centralization of this procedure is desirable. Future studies should clarify specific ways to improve the failure‐to‐rescue rates in certified institutions.

Current role of hepatopancreatoduodenectomy for the management of gallbladder cancer and extrahepatic cholangiocarcinoma: A systematic review

“…In summary, from the recent literature one can argue that HPD including simultaneous major hepatic resection and PD remains an intervention with a high risk of complications, although low perioperative mortality rates can be reached in institutions with high expertise. Centralization in centers of excellence of patients who can benefit from HPD may be a strategy to improve outcomes[ 9 , 38 ].…”

Hepatopancreatoduodenectomy with simultaneous resection of the portal vein and hepatic artery: Ultimate superextended surgery for advanced perihilar cholangiocarcinoma

“…When a tumor has longitudinal extension with downward spread to the intrapancreatic bile duct, major hepatectomy with pancreatoduodenectomy, i.e. hepatopancreatoduodenectomy (HPD), 1 is performed. Undoubtedly Japanese hepatobiliary surgeons have made significant contributions to the progression of HPD for biliary tract cancer.…”

“…These extended resections are technically difficult, still associated with high mortality and morbidity. However, better results with low mortality and acceptable long‐term survival have recently been reported from high‐volume tertiary centers 1, 2 . In addition, superextended resection, i.e.…”

“…However, better results with low mortality and acceptable long-term survival have recently been reported from high-volume tertiary centers. 1,2 In addition, superextended resection, i.e. HPD with vascular resection, is indicated for advanced PHC with both longitudinal and vertical extensions.…”

Prognostic Value of Carbohydrate Antigen 19‐9 and the Surgical Margin in Extrahepatic Cholangiocarcinoma

“…9 , 10 , 11 However, these extensive surgeries are associated with high morbidity and mortality rates. 10 , 11 , 12 , 13 Thus, high‐risk surgeries should be performed for patients who are expected to benefit from R0 resection. However, the significance of R0 resection has not been fully discussed.…”