Systematic Reviews
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jun 15, 2021; 13(6): 625-637
Published online Jun 15, 2021. doi: 10.4251/wjgo.v13.i6.625
Current role of hepatopancreatoduodenectomy for the management of gallbladder cancer and extrahepatic cholangiocarcinoma: A systematic review
Alessandro Fancellu, Valeria Sanna, Giulia Deiana, Chiara Ninniri, Davide Turilli, Teresa Perra, Alberto Porcu
Alessandro Fancellu, Giulia Deiana, Chiara Ninniri, Teresa Perra, Alberto Porcu, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari 07100, Italy
Valeria Sanna, Unit of Oncology, AOU Sassari, Sassari 07100, Italy
Davide Turilli, Unit of Radiology, AOU Sassari, Sassari 07100, Italy
Author contributions: Fancellu A, and Porcu A contributed to this paper with conception and study design, manuscript writing and critical revision; Sanna V contributed with manuscript drafting and critical revision of oncologic outcomes; Deiana G, Ninniri C, and Perra T contributed with literature review and analysis, drafting and critical revision/editing; Turilli D contributed to tables and figures drafting; all authors have read and approved the final manuscript.
Conflict-of-interest statement: The authors do not have any conflicts of interest relevant to this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist statement, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Alessandro Fancellu, FACS, MD, PhD, Associate Professor, Department of Medical, Surgical and Experimental Sciences, University of Sassari, V.le San Pietro 43, Sassari 07100, Italy.
Received: March 5, 2021
Peer-review started: March 5, 2021
First decision: March 29, 2021
Revised: April 3, 2021
Accepted: May 25, 2021
Article in press: May 25, 2021
Published online: June 15, 2021

Hepatopancreatoduodenectomy (HPD) is the simultaneous combination of hepatic resection, pancreaticoduodenectomy, and resection of the entire extrahepatic biliary system. HPD is not a universally accepted due to high mortality and morbidity rates, as well as to controversial survival benefits.


To evaluate the current role of HPD for curative treatment of gallbladder cancer (GC) or extrahepatic cholangiocarcinoma (ECC) invading both the hepatic hilum and the intrapancreatic common bile duct.


A systematic literature search using the PubMed, Web of Science, and Scopus databases was performed to identify studies reporting on HPD, using the following keywords: ‘Hepatopancreaticoduodenectomy’, ‘hepatopancreatoduodenectomy’, ‘hepatopancreatectomy’, ‘pancreaticoduodenectomy’, ‘hepatectomy’, ‘hepatic resection’, ‘liver resection’, ‘Whipple procedure’, ‘bile duct cancer’, ‘gallbladder cancer’, and ‘cholangiocarcinoma’.


This updated systematic review, focusing on 13 papers published between 2015 and 2020, found that rates of morbidity for HPD have remained high, ranging between 37.0% and 97.4%, while liver failure and pancreatic fistula are the most serious complications. However, perioperative mortality for HPD has decreased compared to initial experiences, and varies between 0% and 26%, although in selected center it is well below 10%. Long term survival outcomes can be achieved in selected patients with R0 resection, although 5–year survival is better for ECC than GC.


The present review supports the role of HPD in patients with GC and ECC with horizontal spread involving the hepatic hilum and the intrapancreatic bile duct, provided that it is performed in centers with high experience in hepatobiliary-pancreatic surgery. Extensive use of preoperative portal vein embolization, and preoperative biliary drainage in patients with obstructive jaundice, represent strategies for decreasing the occurrence and severity of postoperative complications. It is advisable to develop internationally-accepted protocols for patient selection, preoperative assessment, operative technique, and perioperative care, in order to better define which patients would benefit from HPD.

Keywords: Hepatopancreatoduodenectomy, Extrahepatic cholangiocarcinoma, Gallbladder cancer, Survival, Morbidity, Mortality

Core Tip: Hepatopancreatoduodenectomy (HPD) is a complex operation that may achieve curative treatment for selected patients with locally advanced gallbladder cancer and extrahepatic cholangiocarcinoma. However, it represents a surgical procedure with high morbidity and mortality rates, that should be performed in centers with high experience in hepatobiliary-pancreatic surgery. Internationally-accepted protocols on selection criteria, preoperative assessment, operative technique, and perioperative care, are needed in order to better define which patients would benefit from HPD.