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
Research background

Hepatopancreatoduodenectomy (HPD) is a challenging procedure that can be used for treatment of gallbladder cancer or extrahepatic cholangiocarcinoma invading the hepatic hilum and the intrapancreatic common bile duct. Due to high mortality and morbidity rates, as well as to controversial survival benefits, HPD is not a universally accepted procedure.

Research motivation

The aim of this review was to consolidate the evidence currently available on HPD for the treatment of gallbladder cancer and extrahepatic cholangiocarcinoma in a systematic fashion.

Research objectives

The main outcomes of interest were morbidity rates, mortality rates and survival outcomes after HPD for treatment of gallbladder cancer or extrahepatic cholangiocarcinoma.

Research methods

A systematic literature search was performed in PubMed, Web of Science, and Scopus databases to identify studies reporting on HPD during the time-frame 2015-2020.

Research results

Thirteen studies were included in this systematic review. Mortality rates varied among studies from Eastern and Western countries. In selected centers from Japan with high expertise in the hepatobiliary surgery, mortality rates were below 10%. Morbidity rates, albeit variable, were reported in more than 50% of patients. Five-year survival after HPD was higher in patients with extrahepatic cholangiocarcinoma than gallbladder carcinoma, and can be considered acceptable in cases were a R0 resection was obtained.

Research conclusions

The present review supports the role of hepatopancreaticoduodenectomy in selected patients with gallbladder cancer and extrahepatic cholangiocarcinoma, provided that a R0 resection is achieved. Preoperative portal vein embolization and preoperative biliary drainage in jaundiced patients represent strategies for decreasing the occurrence and severity of postoperative complications.

Research perspectives

The present review may be useful as a reference for best practices in the clinical setting, since it addresses the insights from the most recent experiences in the use of heptopancreaticoduodenectomy. Internationally-accepted protocols on selection criteria, preoperative assessment, operative technique, and perioperative care, are warranted to identify patients who would benefit from HPD.