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

Table 1 Recent studies reporting on the use of HPD (published between 2015 and 2020)¹

Ref.	Country	No. of patients submitted to HPD	Time frame	Inclusion criteria	Main conclusions
Tran et al[23], 2015	United States	1072	2005-2013	ECC, GC, pancreatic cancer, benign pancreatic disease NET, secondary liver cancer	A synchronous hemihepatectomy (or trisectionectomy) with PD remains a high morbid combination and should be reserved for patients who have undergone extremely cautious selection.
Fukami et al[15], 2016	Japan	38	1994-2014	ECC, GC	Major HPD with resection of the hepatic artery can be a preferable option for ECC with acceptable perioperative morbidity and mortality, as well as long-term survival. This procedure for GC should not be performed.
Fernandes et al[8], 2016	Brazil	35	2004-2014	ECC, GC, NET, secondary liver cancer/liver direct infiltration	Major liver resection with PD is associated to very high mortality. Efforts to ensure a remnant liver over 40%-50% of the total liver volume is the key to obtain patient survival.
Aoki et al[21], 2016	Japan	52	1994-2014	ECC, GC	HPD can be safely performed using the presently reported surgical strategies with acceptable short and long-term outcomes.
Dai et al[13], 2017	China	12	1998-2014	ECC, GC, HCC, liver sarcoma	Morbidity and mortality after HPD were significant. With R0 resection, the 5-year OS and DFS rates were 27.8% and 29.6%, respectively.
Lee et al[41], 2018	Korea	22	2004-2013	ECC, GC	HPD for GC and ECC can be performed with acceptable mortality and morbidity rates. GC patients who underwent HPD showed comparable survival rates compared with ECC patients.
Welch et al[9], 2019	United States	23	2014-2016	ECC, GC, pancreatic cancer, NET, liver cancer, other malignancy, benign disease	The morbidity and mortality after HPD are significantly higher than after major hepatectomy or PD alone. Centralization of HPD to a very few centers may be a strategy to improve outcomes.
Mizuno et al[37], 2019	Japan	38	1996-2016	GC	HPD for GC is associated with poor OS, high morbidity and mortality rates compared to hepatic resection. Although HPD may eradicate locally spreading GC, the procedure is questioned from an oncological view.
D’Souza et al[10], 2019	Sweden3	66	2003-2018	ECC, GC	HPD, although associated with substantial perioperative mortality, can offer a survival benefit in patient subgroups with ECC and GC. To achieve negative resection margins is paramount for an improved survival.
Toyoda et al[43], 2019	Japan	100	2001-2017	ECC	Presurgical cholangiographic classification, diffuse or localized type, is a tumor-related factor closely associated with survival; therefore, it may be a useful feature for patient selection prior to HPD for ECC.
Liu et al[11], 2020	China	16	2007-2017	ECC	The radical resection of ECC combined with the partial resection of the pancreatic head in some selected patients can actually replace HPD as a surgical treatment for ECC with distal bile duct involvement.
Shimizu et al[28], 2020	Japan	37	1990-2019	ECC	HPD is a valid treatment option for extensive cholangiocarcinoma, offering long-term survival benefit at the cost of relatively high but acceptable morbidity and mortality. HPD is advocated in selected patients provided that it is considered possible to achieve R0 resection.
Oba et al[42], 2020	Japan	36	1998-2018	ECC	Invasive tumor thickness could be measured using simple methods and may be used to stratify postoperative prognosis in patients with ECC.

¹Only articles reporting on at least 10 cases of HPD were included.

²The paper was focused on patients receiving “hepatopancreatectomy”, of whom 107 received HPD and 373 hepatic resection plus distal pancreatectomy.

³This is a multicentric study from 19 European countries.

GC: Gallbladder cancer; ECC: Extrahepatic cholangiocarcinoma; HCC: Hepatocarcinoma; HPD: Hepatopancreatoduodenectomy; NET: Neuroendocrine tumour; OS: Overall survival; DFS: Disease-free survival.