Reassessing the Role of Hepatopancreatoduodenectomy in Advanced Biliary Tract Cancer: A Systematic Review and Single-Arm Meta-Analysis of Modern Case Series.

BACKGROUND

This study aimed to assess perioperative safety and long-term survival after hepatopancreatoduodenectomy (HPD) by performing a systematic review and single-arm meta-analysis of studies published since 2005. The HPD procedure is a high-risk but potentially curative treatment for advanced bile duct and gallbladder cancers. Although perioperative outcomes have improved over time, an updated synthesis of contemporary evidence remains limited.

METHODS

The PubMed, Embase, and Web of Science databases were systematically searched to identify studies published between January 2005 and March 2025. Eligible studies reported outcomes of HPD for bile duct or gallbladder cancers. Pooled estimates for morbidity, 90 day mortality, R0 resection, and 5 year overall survival (OS) rates were calculated using random- or common-effects models. Risk of bias was assessed using the ROBINS-I tool.

RESULTS

This meta-analysis included 18 studies involving 707 patients. The pooled morbidity rate was 0.64 (95% confidence interval [CI, 0.53-0.74), and the 90 day mortality rate was 0.10 (95% CI, 0.05-0.20). The R0 resection rate was 0.79 (95% CI, 0.76-0.82), and the 5 year OS was 0.32 (95% CI, 0.28-0.37). Subgroup analyses showed better perioperative outcomes for gallbladder cancer but superior long-term survival for bile duct cancer.

CONCLUSIONS

The HPD procedure offers an acceptable perioperative risk and favorable long-term survival for selected patients, particularly those with bile duct cancer. In contrast, the lack of long-term survival benefit of HPD for gallbladder cancer supports the prevailing view that HPD should not be routinely recommended for this indication. These findings provide contemporary benchmarks and may inform refinement of surgical indication criteria for HPD.