BACKGROUND: Hepatopancreatoduodenectomy (HPD) is an aggressive operation for treatment of advanced bile duct and gallbladder cancer associated with high perioperative morbidity and mortality, and uncertain oncological benefit in terms of survival. Few reports on HPD from Western centers exist. The purpose of this study was to evaluate safety and efficacy for HPD in European centers. METHOD: Members of the European-African HepatoPancreatoBiliary Association were invited to report all consecutive patients operated with HPD for bile duct or gallbladder cancer between January 2003 and January 2018. The patient and tumor characteristics, perioperative and survival outcomes were analyzed. RESULTS: In total, 66 patients from 19 European centers were included in the analysis. 90-day mortality rate was 17% and 13% for bile duct and gallbladder cancer respectively. All factors predictive of perioperative mortality were patient and disease-specific. The three-year overall survival excluding 90-day mortality was 80% for bile duct and 30% for gallbladder cancer (P = 0.013). In multivariable analysis R0-resection had a significant impact on overall survival. CONCLUSION: HPD, although being associated with substantial perioperative mortality, can offer a survival benefit in patient subgroups with bile duct cancer and gallbladder cancer. To achieve negative resection margins is paramount for an improved survival outcome.

Department of Clinical Science Intervention and Technology Karolinska Institutet and Karolinska University Hospital Stockholm Sweden

Department of Clinical Sciences Lund Surgery Lund University Skane University Hospital Lund Sweden

Department of Digestive and Hepatobiliary Pancreatic Surgery AZ Groeninge Kortrijk Belgium

Department of Hepatobiliary and Pancreatic Surgery Queen Elizabeth Hospital Birmingham United Kingdom

Department of Hepatobiliary and Transplant Surgery St Vincent's University Hospital Elm Park Dublin Ireland

Department of Hepatobiliary Surgery and Visceral Transplantation University Medical Center Hamburg Eppendorf Hamburg Germany

Department of Hepatobiliary Surgery Leeds Teaching Hospitals NHS Trust Leeds United Kingdom

Department of HPB and Digestive Surgery Ospedale Mauriziano Umberto 1 Turin Italy

Department of HPB and Liver Transplant Surgery Royal Free Hospital NHS Foundation Trust London United Kingdom

Department of HPB Surgery and Liver Transplantation Beaujon Hospital Clichy France

Department of Surgery 2 Faculty of Medicine Charles University and Central Military Hospital Prague 16002 Czech Republic

Department of Surgery Amsterdam University Medical Centres location AMC Amsterdam the Netherlands

Department of Surgery and Liver Transplantation Croix Rousse University Hospital University of Lyon Lyon France

Department of Surgery Division of Hepatopancreatobiliary Surgery and Liver Transplantation University Medical Center Groningen University of Groningen Groningen the Netherlands

Department of Surgery General and Hepatobiliary Surgery Unit Verona University Hospital Verona Italy

Department of Surgery Heinrich Heine University and University Hospital Düsseldorf Düsseldorf Germany

Department of Surgery Hospital del Mar Barcelona Spain

Department of Surgery Maastricht University Medical Center Maastricht the Netherlands

Department of Surgery University Medical Center Utrecht Utrecht the Netherlands

Department of Visceral Transplantation and Thoracic Surgery Medical University of Innsbruck Innsbruck Austria

Hepatobiliary and Pancreatic Surgery Unit General Surgery Department Joan XXIII University Hospital Tarragona Spain

Hepatobiliopancreatic Surgery Unit General and Digestive Surgery Service Hospital Miguel Servet Zaragoza Spain

Surrey and Sussex Regional HPB Unit Royal Surrey County Hospital Guildford United Kingdom

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