Systematic Reviews
Copyright ©The Author(s) 2021.
World J Gastrointest Oncol. Jun 15, 2021; 13(6): 625-637
Published online Jun 15, 2021. doi: 10.4251/wjgo.v13.i6.625
Table 1 Recent studies reporting on the use of HPD (published between 2015 and 2020)1
Ref.CountryNo. of patients submitted to HPDTime frameInclusion criteriaMain conclusions
Tran et al[23], 2015United States10722005-2013ECC, GC, pancreatic cancer, benign pancreatic disease NET, secondary liver cancerA 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], 2016Japan381994-2014ECC, GCMajor 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], 2016Brazil352004-2014ECC, GC, NET, secondary liver cancer/liver direct infiltrationMajor 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], 2016Japan521994-2014ECC, GCHPD can be safely performed using the presently reported surgical strategies with acceptable short and long-term outcomes.
Dai et al[13], 2017China121998-2014ECC, GC, HCC, liver sarcomaMorbidity 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], 2018Korea222004-2013ECC, GCHPD 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], 2019United States232014-2016ECC, GC, pancreatic cancer, NET, liver cancer, other malignancy, benign diseaseThe 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], 2019Japan381996-2016GCHPD 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], 2019Sweden3662003-2018ECC, GCHPD, 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], 2019Japan1002001-2017ECCPresurgical 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], 2020China162007-2017ECCThe 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], 2020Japan371990-2019ECCHPD 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], 2020Japan361998-2018ECCInvasive tumor thickness could be measured using simple methods and may be used to stratify postoperative prognosis in patients with ECC.
Table 2 Studies reporting on morbidity and mortality outcomes for gallbladder cancer and extrahepatic cholangiocarcinoma after hepatopancreatoduodenectomy (years 2015-2020)
Ref.Total n of patientsMorbidity (%)Perioperative mortality (%)
Tran et al[23], 201510787.5318.24
Fukami et al[15], 20163844.7113.5
Fernandes et al[8], 20163597.434.2
Aoki et al[21], 20165237.010
Dai et al[13], 20171283.325.0
Lee et al[41], 20182268.24.5
Welch et al[9], 20192387.026.0
Mizuno et al[37], 20193887.0118.0
D’Souza et al[10], 20196650.0115.0
Toyoda et al[43], 201910081.010%2
Liu et al[11], 20201662.512.5
Shimizu et al[28], 20203751.415.4
Table 3 Studies reporting on survival outcomes after hepatopancreatoduodenectomy for gallbladder cancer and extrahepatic cholangiocarcinoma (2015-2020)
Ref.Total n of patientsGCECCSurvival outcomes
Aoki et al[21], 2016521339NR3NR3
Lee et al[41], 20182281425.0%217.9%2
D’Souza et al[10], 2019663135 30.0%1 80.0%1
Toyoda et al[43], 20191000100-49.2%2
Liu et al[11], 202016016-20.0%2
Shimizu et al[28], 202037037-36.8%2