THE LARGEST WESTERN EXPERIENCE WITH HEPATOPANCREATODUODENECTOMY: LESSONS LEARNED WITH 35 CASES.

Autor:	Fernandes Ede S; Department of Surgery, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil., Mello FT; Department of Surgery and Transplantation of Rio de Janeiro, Adventist Hospital, Rio de Janeiro, RJ, Brazil., Ribeiro-Filho J; Department of Surgery, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil., Monte-Filho AP; Department of Surgery, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil., Fernandes MM; Department of Digestive Surgery, Pio XII Hospital, São Jose dos Campos, SP, Brazil., Coelho RJ; Department of Surgery and Transplantation of Rio de Janeiro, Adventist Hospital, Rio de Janeiro, RJ, Brazil., Matos MC; Department of Surgery and Transplantation of Rio de Janeiro, Adventist Hospital, Rio de Janeiro, RJ, Brazil., Souza AA; Department of Surgery, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil., Torres OJ; Department of Surgery, Federal University of Maranhão, MA, Brazil.
Jazyk:	English; Portuguese
Zdroj:	Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery [Arq Bras Cir Dig] 2016 Mar; Vol. 29 (1), pp. 17-20.
DOI:	10.1590/0102-6720201600010005
Abstrakt:	Background: Hepatopancreatoduodenectomy is one of the most complex abdominal operations mainly indicated in advanced biliary carcinoma. Aim: To present 10-year experience performing this operation in advanced malignant tumors. Methods: This is a retrospective descriptive study. From 2004 to 2014, 35 hepatopancreatoduodenectomies were performed in three different institutions. The most common indication was advanced biliary carcinoma in 24 patients (68.5%). Results: Eighteen patients had gallbladder cancer, eight Klatskin tumors, five neuroendocrine tumors with liver metastasis, one colorectal metastasis invading the pancreatic head, one intraductal papillary mucinous neoplasm with liver metastasis, one gastric cancer recurrence with liver involvement and one ocular melanoma with pancreatic head and right liver lobe metastasis. All patients were submitted to pancreatoduodenectomy with a liver resection as follows: eight right trisectionectomies, five right lobectomies, four left lobectomies, 18 central lobectomies (IVb, V and VIII). The overall mortality was 34.2% (12/35) and the overall morbidity rate was 97.4%. Conclusion: Very high mortality is seen when major liver resection is performed with pancreatoduodenectomy, including right lobectomy and trisectionectomy. Liver failure in combination with a pancreatic leak is invariably lethal. Efforts to ensure a remnant liver over 40-50% of the total liver volume are the key to obtain patient survival.
Databáze:	MEDLINE
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