Pancreatoduodenalectomy with hemihepatectomy — analysis of clinical experience

Hepatopancreatoduodenalectomy is a complex and traumatic surgical intervention, which is accompanied by an extremely high frequency of postoperative complications and mortality, reaching 97.4% and 26%, respectively. Objective. To analyze the clinical experience of pancreaticoduodenal resections with hemihepatectomy for various malignant neoplasms. Material and methods. The analysis included seven patients who underwent pancreaticoduodenal resection with hemihepatectomy for various malignant tumors. Two patients had neuroendocrine tumors of the pancreatic head, 2 had bile duct cancer, 1 had renal cancer with synchronous metastases to the pancreatic head and liver, 1 had retroperitoneal sarcoma and 1 had cancer of the hepatic flexure of the colon. Results. Hepatopancreatoduodenalectomy were accompanied by a high frequency of postoperative complications of class 3 and higher according to Clavien-Dindo (85.7%). Three (42.9%) of seven patients developed type B pancreatic fistula. High frequency of intra-abdominal abscesses (28.6%), pneumonia (28.6%) and ulcerative gastric bleeding (28.6%) are noteworthy. Postoperative liver failure type A developed in three patients (42.9%). The operations were accompanied by a significant volume of blood loss with a median of 5500 ml. The median duration of surgery was 300 minutes. The median postoperative hospital stay was 29 days. Postoperative mortality was 14.3%. Conclusion. Hepatopancreatoduodenalectomy are extremely rare surgical interventions, which are accompanied by a high frequency of postoperative complications and mortality even if they are performed in large high-tech centers. Patients for these operations must undergo strict selection to reduce postoperative risks.