Hepatopancreatoduodenectomy (HPD) may provide acceptable oncological outcomes in some patients with widespread extrahepatic cholangiocarcinoma despite its complexity and invasiveness, according to a case series from Italy published in Hepatobiliary & Pancreatic Diseases International.

We believe that this case-series accumulated the cases on the application of HPD in surgical practice,” first author Alberto Porcu and the coauthors of the study wrote. “Standardization of both surgical technique and selection criteria, national-based databases, and centralization of cases in centers with high experience are the keys to identifying patients with [extrahepatic cholangiocarcinoma] who may benefit from HPD.”

The team reported data from 51 male patients, aged 50 to 76 years, with extrahepatic cholangiocarcinoma, 6 of whom underwent HPD between 2010 and 2020. The decision to perform HPD was made during the operation in all cases because of the infiltration of the distal common bile duct at the frozen section.

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Major complications occurred in 4 of the 6 patients, which is in line with previous reports, while 2 patients were still “alive and disease-free” after more than 2 years following the operation.

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Based on these findings, the researchers concluded that HPD still provides acceptable outcomes, but indications and patient selection for extended liver resection should be more restrictive for HPD.

HPD is a complex procedure that includes hepatic resection, pancreatoduodenectomy, and the extirpation of the extrahepatic biliary system. Because of the high mortality and morbidity rates, it has been a controversial operation. Although mortality rates of HPD are historically high compared to other types of major gastrointestinal surgeries, they have dropped remarkably in the last decade. 

Cholangiocarcinoma is a group of rare malignant tumors originating from cells of the biliary tree. There are 3 types of cholangiocarcinoma based on the anatomical origin. These are intrahepatic, perihilar, and distal cholangiocarcinoma. Perihilar and distal cholangiocarcinoma are also known as extrahepatic cholangiocarcinoma. 


Porcu A, Deiana G, Feo CF, et al. Hepatopancreatoduodenectomy for the treatment of extrahepatic cholangiocarcinoma. Hepatobiliary Pancreat Dis Int. Published online August 21, 2022. doi:10.1016/j.hbpd.2022.08.011