Operative outcome and problems of right hepatic lobectomy with pancreatoduodenectomy for advanced carcinoma of the biliary tract.

From 1979 to 1996, 32 patients underwent at least right hepatic lobectomy with pancreatoduodenectomy (right HPD) for advanced carcinoma of the biliary tract at our institute. Twelve of the 32 patients underwent hepatoligamentopancreatoduodenectomy (HLPD). Curative resection was achieved in 20 (63%) of the 32 patients, but the operative outcomes were not satisfactory. Operative deaths occurred in 15 (47%) of the 32 patients, and postoperative complications in 29 (91%). The overall cumulative 1-, 3-, and 5-year survival rates were 12%, 6%, and 3%, respectively. These results suggested that simultaneous hepatectomy of the right lobe and pancreatoduodenectomy is undesirable, especially when accompanied by vascular resection and reconstruction. Since 1997, we have used partial pancreatectomy and partial duodenectomy instead of pancreatoduodenectomy for access to peripancreatic lesions, and this has markedly improved the operative outcome. From 1997 to 2004, 42 patients underwent resection of the right hepatic lobe, extrahepatic bile duct, and other related organs for advanced carcinoma of the biliary tract. There were postoperative complications in 13 (31%), but no operative death occurred. Recent advances in operative procedures and perioperative management may offer greater safety for right HPD, but the appropriate applications of and the necessity for right HPD are still matters of controversy and require further discussion.