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[Indications for and operative outcome of hepatopancreatoduodenectomy in the treatment of gallbladder carcinoma].

Hepatopacreatoduodenectomy (HPD) was initially performed to resect highly advanced gallbladder carcinoma with direct invasion of the liver and head of the pancreas. High operative morbidity and mortality rates and early recurrence were major problems of this procedure. However, the operative outcome gradually improved with progress in surgical procedures and perioperative management. Recently, HPD has been indicated not only for direct invasion of the liver and pancreas but also for intensive dissection of peripancreatic lymph nodes and resection of occult liver metastasis to subsegments IV and V. Evaluation of all cases in which HPD was performed in our institute suggests that advanced gallbladder carcinoma with lymph node metastasis and without high-grade infiltration of the hepatoduodenal ligament (binf) is the most suitable indication for HPD.