A systematic review of safety and efficacy of hepatopancreatoduodenectomy for biliary and gallbladder cancers

Abstract

Objectives: To review the evidence on the safety and efficacy of hepatopancreatoduodenectomy for biliary and gallbladder cancers.

Methods: Medline and EMBASE were systematically searched for papers of hepatopancreatoduodenectomy in patients with biliary and gallbladder cancers.

Results: Eighteen studies involving 397 patients were reviewed. Major hepatectomy was undertaken in 81.3% of the 397 patients and the R0 resection rate was 71.3%. The morbidity and mortality rates were 78.9% and 10.3%, respectively. The 5-year overall survival rate ranged from 3% to 50% (median = 31%). The 5-year survival rate in patients who underwent curative resection was 18-68.8% (median = 51.3%), and 0% in patients who received non-curative resection.

Conclusions: Hepatopancreatoduodenectomy is a challenging procedure with high morbidity and mortality rates. However, this procedure can provide a chance of long-term survival in patients in whom curative resection is feasible.

Figure 1

Flow diagram for the selection of eligible studies

Figure 2

Flow diagram of operative indications and strategies to reduce surgical risk of hepatopancreatoduodenectomy. BC, bile duct cancer; GC, gallbladder cancer; BD, biliary drainage; ^a, ≤20% in normal liver, ≤30% with significant fibrosis or steatosis, and ≤40% in cirrhosis; ^b, soft pancreatic texture and a nondilated pancreatic duct