Hepatoligamentopancreatoduodenectomy in Patients with Advanced Gallbladder Carcinoma

Advanced carcinomas of the gallbladder often involve the hepatoduodenal ligament and have a poor prognosis. Dissection of the hepatoduodenal ligament with preservation of the portal vein and hepatic artery has a high risk of residual tumor and early death. Curative resection in patients with invasion of the hepatoduodenal ligament ideally requires en bloc resection of the entire ligament. F. Hanyu of our department has developed an extended procedure, referred to as hepatoligamentopancreatoduodenectomy (HLPD), for en bloc resection of the right lobe of the liver and head of the pancreas with the hepatoduodenal ligament. This chapter describes the surgical technique of HLPD and outlines the background of its development as well as its indications, long-term outcome, and problems. Curative resection could be performed in all patients using HLPD; however, long-term survival could not be determined and operative mortality was extremely high, thus the clinical significance of HLPD was not established. We concluded that the clinical significance of HLPD for patients with advanced gallbladder carcinoma with hepatoduodenal ligament invasion should be evaluated after the safety of the procedure has been established and the cumulative results of a number of cases have been obtained.