Hepatopancreatoduodenectomy for Multifocal Cholangiocarcinoma in the Setting of Biliary Papillomatosis.

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Abstrakt

Tytuł:: Hepatopancreatoduodenectomy for Multifocal Cholangiocarcinoma in the Setting of Biliary Papillomatosis.
Autorzy:: Iacono C; Division of General and HPB Surgery, Department of Surgery, School of Medicine, University of Verona, Verona, Italy. .
De Bellis M; Division of General and HPB Surgery, Department of Surgery, School of Medicine, University of Verona, Verona, Italy.
Ruzzenente A; Division of General and HPB Surgery, Department of Surgery, School of Medicine, University of Verona, Verona, Italy.
Campagnaro T; Division of General and HPB Surgery, Department of Surgery, School of Medicine, University of Verona, Verona, Italy.
Conci S; Division of General and HPB Surgery, Department of Surgery, School of Medicine, University of Verona, Verona, Italy.
Guglielmi A; Division of General and HPB Surgery, Department of Surgery, School of Medicine, University of Verona, Verona, Italy.
Źródło:: Annals of surgical oncology [Ann Surg Oncol] 2020 Sep; Vol. 27 (9), pp. 3356-3357. Date of Electronic Publication: 2020 Apr 04.
Typ publikacji:: Case Reports; Journal Article; Video-Audio Media
Język:: English
Imprint Name(s):: Publication: 2005- : New York, NY : Springer
Original Publication: New York, NY : Raven Press, c1994-
MeSH Terms:: Bile Duct Neoplasms*/diagnostic imaging
Bile Duct Neoplasms*/surgery
Bile Ducts, Extrahepatic*/diagnostic imaging
Bile Ducts, Extrahepatic*/surgery
Cholangiocarcinoma*/diagnostic imaging
Cholangiocarcinoma*/surgery
Papilloma*/diagnostic imaging
Papilloma*/surgery
Precancerous Conditions/*surgery
Aged ; Bile Ducts, Intrahepatic/diagnostic imaging ; Bile Ducts, Intrahepatic/surgery ; Cholangiopancreatography, Magnetic Resonance ; Hepatectomy ; Humans ; Male ; Pancreaticoduodenectomy ; Precancerous Conditions/diagnostic imaging ; Tomography, X-Ray Computed ; Ultrasonography
References:: Ebata T, Yokoyama Y, Igami T, Sugawara G, Mizuno T, Nagino M. Review of hepatopancreatoduodenectomy for biliary cancer: an extended radical approach of Japanese origin. J Hepatobiliary Pancreat Sci. 2014;21:550–5. https://doi.org/10.1002/jhbp.80 . (PMID: 10.1002/jhbp.8024464987)
Sakamoto Y, Nara S, Kishi Y, etal. Is extended hemihepatectomy plus pancreaticoduodenectomy justified for advanced bile duct cancer and gallbladder cancer? Surgery United States. 2013;153:794–800. https://doi.org/10.1016/j.surg.2012.11.024 . (PMID: 10.1016/j.surg.2012.11.024)
Zhou Y, Zhang Z, Wu L, Li B. A systematic review of safety and efficacy of hepatopancreatoduodenectomy for biliary and gallbladder cancers. HPB. 2016;18:1–6. https://doi.org/10.1016/j.hpb.2015.07.008 . (PMID: 10.1016/j.hpb.2015.07.00826776844)
Lim CS, Jang JY, Lee SE, Kang MJ, Kim SW. Reappraisal of hepatopancreatoduodenectomy as a treatment modality for bile duct and gallbladder cancer. J Gastrointest Surg. 2012;16:1012–8. https://doi.org/10.1007/s11605-012-1826-5 . (PMID: 10.1007/s11605-012-1826-522271243)
Harada F, Matsuyama R, Mori R, et al. Outcomes of surgery for 2010 WHO classification-based intraductal papillary neoplasm of the bile duct: case–control study of a single Japanese institution’s experience with special attention to mucin expression patterns. Eur J Surg Oncol. 2019;45:761–8. https://doi.org/10.1016/j.ejso.2018.10.532 . (PMID: 10.1016/j.ejso.2018.10.53230389302)
Yeh T, Tseng J, Chen T, et al. Cholangiographic spectrum of intraductal papillary mucinous neoplasm of the bile ducts. Ann Surg. 2006;244:248–53. https://doi.org/10.1097/01.sla.0000217636.40050.54 . (PMID: 10.1097/01.sla.0000217636.40050.54168581871602176)
Entry Date(s):: Date Created: 20200406 Date Completed: 20210405 Latest Revision: 20211101
Update Code:: 20240105
DOI:: 10.1245/s10434-020-08357-1
PMID:: 32248378
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Background: Hepatopancreatoduodenectomy is performed to achieve curative resection of malignant biliary tumors.1 However, the morbidity and mortality associated with this challenging surgical procedure remain high, and optimal indications remain unclear.2 - 4 Biliary papillomatosis (BP) is a precursor lesion of cholangiocarcinoma. This video shows hepatopancreatoduodenecomy for multifocal cholangiocarcinoma in the setting of BP.
Patient: A 75-year-old man with a medical history of cholecystectomy presented with obstructive jaundice. Magnetic resonance colangiopancreatography and computed tomography scan showed diffuse biliary dilation with mild enhancing nodularities in the whole extrahepatic bile duct. Cholangioscopy with biopsies proved cholangiocarcinoma arising from BP at the prepapillary common bile duct (CBD) and the biliary confluence. The second-order right ducts were free of disease. The patient underwent nasobiliary drainage and was considered for hepatopancreatoduodenecomy.
Technique: A right subcostal incision was performed. Intraoperative ultrasound showed BP of the intrapancreatic CBD spreading only to the left bile duct. En bloc resection of the left liver, caudate lobe, and CBD was performed together with pylorus-preserving pancreatoduodenectomy. The reconstruction phase was performed on a single-loop by duct-to-mucosa pancreatojejunostomy, two-duct biliojejunostomy with mucosa-to-mucosa alignment, and duodenojejunostomy. Transanastomotic external stents were used for biliary and pancreatic drainage. Histopathologic examination confirmed foci of cholangiocarcinoma arising from BP. Resection margins were negative. Lymph node metastasis, microvascular invasion, perineural invasion, and mucin secretion were absent. The patient was discharged on postoperative day 14 without complications. At the 2-year follow-up assessment, he was alive and free of disease.
Conclusion: Cholangiocarcinoma arising from BP is a proper indication for hepatopancreatoduodenectomy. The long-term oncologic benefits might outweigh the possible perioperative complications.5 , 6.

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