{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T09:56:53Z","timestamp":1770717413522,"version":"3.49.0"},"reference-count":23,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,3,24]],"date-time":"2025-03-24T00:00:00Z","timestamp":1742774400000},"content-version":"vor","delay-in-days":23,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["JGH Open"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>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\u2010operative findings and postoperative outcomes were analyzed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Over 5\u2009years, eight patients underwent HPD. Mean age was 60 (45\u201369) years with a male\u2010to\u2010female ratio of 3:5. Locally advanced carcinoma of the gall bladder (Ca GB) comprised the majority of indications for HPD (<jats:italic>n<\/jats:italic>\u2009=\u20097), 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\u2010anatomical 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\u2009\u00b1\u20091.28\u2009days and 7.62\u2009\u00b1\u20091.41\u2009days, respectively. Clavien\u2010Dindo Grade II or higher morbidity was observed in 5 (62.5%) patients, with one perioperative mortality (12.5%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jgh3.70144","type":"journal-article","created":{"date-parts":[[2025,3,26]],"date-time":"2025-03-26T13:33:26Z","timestamp":1742996006000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Indications and Outcomes of Hepatopancreatoduodenectomy for Gallbladder Carcinoma and Extrahepatic Cholangiocarcinoma: A Single Center Retrospective Study"],"prefix":"10.1002","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-8137-3611","authenticated-orcid":false,"given":"S. D.","family":"Adhikari","sequence":"first","affiliation":[{"name":"Department of GI and General Surgery Kathmandu Medical College and Teaching Hospital  Kathmandu Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R.","family":"Pahari","sequence":"additional","affiliation":[{"name":"Department of GI and General Surgery Kathmandu Medical College and Teaching Hospital  Kathmandu Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P.","family":"Maharjan","sequence":"additional","affiliation":[{"name":"Department of GI and General Surgery Kathmandu Medical College and Teaching Hospital  Kathmandu Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7376-5926","authenticated-orcid":false,"given":"Y.","family":"Limbu","sequence":"additional","affiliation":[{"name":"Department of GI and General Surgery Kathmandu Medical College and Teaching Hospital  Kathmandu Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S.","family":"Regmee","sequence":"additional","affiliation":[{"name":"Department of GI and General Surgery Kathmandu Medical College and Teaching Hospital  Kathmandu Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R.","family":"Ghimire","sequence":"additional","affiliation":[{"name":"Department of GI and General Surgery Kathmandu Medical College and Teaching Hospital  Kathmandu Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D. K.","family":"Maharjan","sequence":"additional","affiliation":[{"name":"Department of GI and General Surgery Kathmandu Medical College and Teaching Hospital  Kathmandu Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S. K.","family":"Shrestha","sequence":"additional","affiliation":[{"name":"Department of GI and General Surgery Kathmandu Medical College and Teaching Hospital  Kathmandu Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P. B.","family":"Thapa","sequence":"additional","affiliation":[{"name":"Department of GI and General Surgery Kathmandu Medical College and Teaching Hospital  Kathmandu Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,3,24]]},"reference":[{"issue":"4","key":"e_1_2_7_2_1","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1007\/s00423-016-1413-4","article-title":"Major Hepatopancreatoduodenectomy With Simultaneous Resection of the Hepatic Artery for Advanced Biliary Cancer","volume":"401","author":"Fukami Y.","year":"2016","journal-title":"Langenbeck's Archives of Surgery"},{"key":"e_1_2_7_3_1","first-page":"923","article-title":"Our Experiences (5 Cases) of Extended Right Lobectomy Combined With Pancreato\u2010Duodenectomy for the Carcinoma of the Gall Bladder","volume":"1","author":"Takasaki K.","year":"1980","journal-title":"Tan to Sui"},{"issue":"8","key":"e_1_2_7_4_1","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1002\/jhbp.80","article-title":"Review of Hepatopancreatoduodenectomy for Biliary Cancer: An Extended Radical Approach of Japanese Origin","volume":"21","author":"Ebata T.","year":"2014","journal-title":"Journal of Hepato\u2010Biliary\u2010Pancreatic Sciences"},{"issue":"3","key":"e_1_2_7_5_1","first-page":"360","article-title":"Hepatopancreatoduodenectomy in North America: Are the Outcomes Acceptable?","volume":"22","author":"Welch J. C.","year":"2020","journal-title":"Hepato Pancreato Biliary"},{"issue":"2","key":"e_1_2_7_6_1","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1007\/s00534-006-1106-4","article-title":"Right Hepatopancreatoduodenectomy: Improvements Over 23\u2009Years to Attain Acceptability","volume":"14","author":"Ebata T.","year":"2007","journal-title":"Journal of Hepato\u2010Biliary\u2010Pancreatic Surgery"},{"issue":"2","key":"e_1_2_7_7_1","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1097\/SLA.0b013e31826029ca","article-title":"Hepatopancreatoduodenectomy for Cholangiocarcinoma: A Single\u2010Center Review of 85 Consecutive Patients","volume":"256","author":"Ebata T.","year":"2012","journal-title":"Annals of Surgery"},{"key":"e_1_2_7_8_1","first-page":"332","volume-title":"Annals of Surgery","author":"Aoki T.","year":"2018"},{"key":"e_1_2_7_9_1","unstructured":"S.Nakamura R.Nishiyama Y.Yokoi et\u00a0al. \u201cHepatopancreatoduodenectomy for Advanced Gallbladder Carcinoma\u201d http:\/\/archsurg.jamanetwork.com\/."},{"issue":"1","key":"e_1_2_7_10_1","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1590\/0102-6720201600010005","article-title":"The Largest Western Experience With Hepatopancreatoduodenectomy: Lessons Learned With 35 Cases","volume":"29","author":"Fernandes S. 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