Abstract
INTRODUCTION: Hepatopancreatoduodenectomy (HPD) is the only definitive approach to achieve curative resection in locally advanced biliary tract cancers. The study intends to analyze outcomes of this complex surgery in a tertiary care center in Nepal. METHODS: This retrospective study included all patients who underwent HPD for locally advanced biliary tract tumors in Kathmandu Medical College Teaching Hospital from January 1, 2019 to December 31, 2023. Intra-operative findings and postoperative outcomes were analyzed. RESULTS: Over 5 years, eight patients underwent HPD. Mean age was 60 (45-69) years with a male-to-female ratio of 3:5. Locally advanced carcinoma of the gall bladder (Ca GB) comprised the majority of indications for HPD (n = 7), two of which had biliary infiltration. Others had either a conglomerated station 13 lymph node, duodenal infiltration, or both. Segment IV and V of the liver were resected in five patients, and right hemihepatectomy with non-anatomical wedge resection of segment IVb was performed in two patients with right hepatic artery involvement. One patient underwent right hemihepatectomy for Bismuth Type IIIa perihilar tumor with distal biliary infiltration and right hepatic artery involvement. R0 resection was achieved in 62.5% of the patients. All three patients with tumor infiltrating the biliary tract had R1 resection. Mean ICU and hospital stay was 2.75 ± 1.28 days and 7.62 ± 1.41 days, respectively. Clavien-Dindo Grade II or higher morbidity was observed in 5 (62.5%) patients, with one perioperative mortality (12.5%). CONCLUSION: R0 resection with acceptable morbidity can be achieved in selected cases of Ca GB with conglomerated station 13 lymph nodes; however, R0 remains challenging in cases of biliary infiltration.