Hepatopancreatoduodenectomy for Multifocal Cholangiocarcinoma in the Setting of Biliary Papillomatosis
Background Hepatopancreatoduodenectomy is performed to achieve curative resection of malignant biliary tumors. 1 However, the morbidity and mortality associated with this challenging surgical procedure remain high, and optimal indications remain unclear. 2 – 4 Biliary papillomatosis (BP) is a precur...
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| Veröffentlicht in: | Annals of surgical oncology 2020-09, Vol.27 (9), p.3356-3357 |
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| creator | Iacono, Calogero De Bellis, Mario Ruzzenente, Andrea Campagnaro, Tommaso Conci, Simone Guglielmi, Alfredo |
| description | Background
Hepatopancreatoduodenectomy is performed to achieve curative resection of malignant biliary tumors.
1
However, the morbidity and mortality associated with this challenging surgical procedure remain high, and optimal indications remain unclear.
2
–
4
Biliary papillomatosis (BP) is a precursor lesion of cholangiocarcinoma. This video shows hepatopancreatoduodenecomy for multifocal cholangiocarcinoma in the setting of BP.
Patient
A 75-year-old man with a medical history of cholecystectomy presented with obstructive jaundice. Magnetic resonance colangiopancreatography and computed tomography scan showed diffuse biliary dilation with mild enhancing nodularities in the whole extrahepatic bile duct. Cholangioscopy with biopsies proved cholangiocarcinoma arising from BP at the prepapillary common bile duct (CBD) and the biliary confluence. The second-order right ducts were free of disease. The patient underwent nasobiliary drainage and was considered for hepatopancreatoduodenecomy.
Technique
A right subcostal incision was performed. Intraoperative ultrasound showed BP of the intrapancreatic CBD spreading only to the left bile duct. En bloc resection of the left liver, caudate lobe, and CBD was performed together with pylorus-preserving pancreatoduodenectomy. The reconstruction phase was performed on a single-loop by duct-to-mucosa pancreatojejunostomy, two-duct biliojejunostomy with mucosa-to-mucosa alignment, and duodenojejunostomy. Transanastomotic external stents were used for biliary and pancreatic drainage. Histopathologic examination confirmed foci of cholangiocarcinoma arising from BP. Resection margins were negative. Lymph node metastasis, microvascular invasion, perineural invasion, and mucin secretion were absent. The patient was discharged on postoperative day 14 without complications. At the 2-year follow-up assessment, he was alive and free of disease.
Conclusion
Cholangiocarcinoma arising from BP is a proper indication for hepatopancreatoduodenectomy. The long-term oncologic benefits might outweigh the possible perioperative complications.
5
,
6 |
| doi_str_mv | 10.1245/s10434-020-08357-1 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_journals_2430817017</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2430817017</sourcerecordid><originalsourceid>FETCH-LOGICAL-c342t-e8b43ad2f5a1a806da2ad12356580843a18037117529a9af4a7d47d6099d3663</originalsourceid><addsrcrecordid>eNp9kMtOwzAQRS0EolD4ARbIEuuAn4mzhAooUhFIdG-5sdO6SuJgO4v-PS4psGM1rzt3RgeAK4xuMWH8LmDEKMsQQRkSlBcZPgJnmKcWywU-TjnKRVaSnE_AeQhbhHBBET8FE0oIE7QQZ6Cem15F16uu8iYlenDadKaKrt3B2nn4OjTR1q5SDZxtXKO6tU2Fr2znWgVtB-PGwA8To-3W0NXwwTZW-R18V71tmqSJLthwAU5q1QRzeYhTsHx6XM7m2eLt-WV2v8gqykjMjFgxqjSpucJKoFwrojQmlOdcIJFGWCBaYFxwUqpS1UwVmhU6R2WpaZ7TKbgZbXvvPgcToty6wXfpoiSMIoGLPYIpIKOq8i4Eb2rZe9umpyVGck9WjmRlIiu_yUqclq4P1sOqNfp35QdlEtBRENKoWxv_d_sf2y_efoSf</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2430817017</pqid></control><display><type>article</type><title>Hepatopancreatoduodenectomy for Multifocal Cholangiocarcinoma in the Setting of Biliary Papillomatosis</title><source>MEDLINE</source><source>SpringerNature Journals</source><creator>Iacono, Calogero ; De Bellis, Mario ; Ruzzenente, Andrea ; Campagnaro, Tommaso ; Conci, Simone ; Guglielmi, Alfredo</creator><creatorcontrib>Iacono, Calogero ; De Bellis, Mario ; Ruzzenente, Andrea ; Campagnaro, Tommaso ; Conci, Simone ; Guglielmi, Alfredo</creatorcontrib><description>Background
Hepatopancreatoduodenectomy is performed to achieve curative resection of malignant biliary tumors.
1
However, the morbidity and mortality associated with this challenging surgical procedure remain high, and optimal indications remain unclear.
2
–
4
Biliary papillomatosis (BP) is a precursor lesion of cholangiocarcinoma. This video shows hepatopancreatoduodenecomy for multifocal cholangiocarcinoma in the setting of BP.
Patient
A 75-year-old man with a medical history of cholecystectomy presented with obstructive jaundice. Magnetic resonance colangiopancreatography and computed tomography scan showed diffuse biliary dilation with mild enhancing nodularities in the whole extrahepatic bile duct. Cholangioscopy with biopsies proved cholangiocarcinoma arising from BP at the prepapillary common bile duct (CBD) and the biliary confluence. The second-order right ducts were free of disease. The patient underwent nasobiliary drainage and was considered for hepatopancreatoduodenecomy.
Technique
A right subcostal incision was performed. Intraoperative ultrasound showed BP of the intrapancreatic CBD spreading only to the left bile duct. En bloc resection of the left liver, caudate lobe, and CBD was performed together with pylorus-preserving pancreatoduodenectomy. The reconstruction phase was performed on a single-loop by duct-to-mucosa pancreatojejunostomy, two-duct biliojejunostomy with mucosa-to-mucosa alignment, and duodenojejunostomy. Transanastomotic external stents were used for biliary and pancreatic drainage. Histopathologic examination confirmed foci of cholangiocarcinoma arising from BP. Resection margins were negative. Lymph node metastasis, microvascular invasion, perineural invasion, and mucin secretion were absent. The patient was discharged on postoperative day 14 without complications. At the 2-year follow-up assessment, he was alive and free of disease.
Conclusion
Cholangiocarcinoma arising from BP is a proper indication for hepatopancreatoduodenectomy. The long-term oncologic benefits might outweigh the possible perioperative complications.
5
,
6</description><identifier>ISSN: 1068-9265</identifier><identifier>EISSN: 1534-4681</identifier><identifier>DOI: 10.1245/s10434-020-08357-1</identifier><identifier>PMID: 32248378</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Aged ; Bile ; Bile Duct Neoplasms - diagnostic imaging ; Bile Duct Neoplasms - surgery ; Bile ducts ; Bile Ducts, Extrahepatic - diagnostic imaging ; Bile Ducts, Extrahepatic - surgery ; Bile Ducts, Intrahepatic - diagnostic imaging ; Bile Ducts, Intrahepatic - surgery ; Cholangiocarcinoma ; Cholangiocarcinoma - diagnostic imaging ; Cholangiocarcinoma - surgery ; Cholangiopancreatography, Magnetic Resonance ; Cholecystectomy ; Computed tomography ; Hepatectomy ; Hepatobiliary Tumors ; Humans ; Implants ; Jaundice ; Lymph nodes ; Male ; Medicine ; Medicine & Public Health ; Metastases ; Microvasculature ; Morbidity ; Mucin ; Mucosa ; Oncology ; Pancreas ; Pancreaticoduodenectomy ; Papilloma ; Papilloma - diagnostic imaging ; Papilloma - surgery ; Precancerous Conditions - diagnostic imaging ; Precancerous Conditions - surgery ; Surgery ; Surgical drains ; Surgical Oncology ; Tomography, X-Ray Computed ; Tumors ; Ultrasonography ; Ultrasound ; Wound drainage</subject><ispartof>Annals of surgical oncology, 2020-09, Vol.27 (9), p.3356-3357</ispartof><rights>Society of Surgical Oncology 2020</rights><rights>Society of Surgical Oncology 2020.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c342t-e8b43ad2f5a1a806da2ad12356580843a18037117529a9af4a7d47d6099d3663</citedby><cites>FETCH-LOGICAL-c342t-e8b43ad2f5a1a806da2ad12356580843a18037117529a9af4a7d47d6099d3663</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1245/s10434-020-08357-1$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1245/s10434-020-08357-1$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32248378$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Iacono, Calogero</creatorcontrib><creatorcontrib>De Bellis, Mario</creatorcontrib><creatorcontrib>Ruzzenente, Andrea</creatorcontrib><creatorcontrib>Campagnaro, Tommaso</creatorcontrib><creatorcontrib>Conci, Simone</creatorcontrib><creatorcontrib>Guglielmi, Alfredo</creatorcontrib><title>Hepatopancreatoduodenectomy for Multifocal Cholangiocarcinoma in the Setting of Biliary Papillomatosis</title><title>Annals of surgical oncology</title><addtitle>Ann Surg Oncol</addtitle><addtitle>Ann Surg Oncol</addtitle><description>Background
Hepatopancreatoduodenectomy is performed to achieve curative resection of malignant biliary tumors.
1
However, the morbidity and mortality associated with this challenging surgical procedure remain high, and optimal indications remain unclear.
2
–
4
Biliary papillomatosis (BP) is a precursor lesion of cholangiocarcinoma. This video shows hepatopancreatoduodenecomy for multifocal cholangiocarcinoma in the setting of BP.
Patient
A 75-year-old man with a medical history of cholecystectomy presented with obstructive jaundice. Magnetic resonance colangiopancreatography and computed tomography scan showed diffuse biliary dilation with mild enhancing nodularities in the whole extrahepatic bile duct. Cholangioscopy with biopsies proved cholangiocarcinoma arising from BP at the prepapillary common bile duct (CBD) and the biliary confluence. The second-order right ducts were free of disease. The patient underwent nasobiliary drainage and was considered for hepatopancreatoduodenecomy.
Technique
A right subcostal incision was performed. Intraoperative ultrasound showed BP of the intrapancreatic CBD spreading only to the left bile duct. En bloc resection of the left liver, caudate lobe, and CBD was performed together with pylorus-preserving pancreatoduodenectomy. The reconstruction phase was performed on a single-loop by duct-to-mucosa pancreatojejunostomy, two-duct biliojejunostomy with mucosa-to-mucosa alignment, and duodenojejunostomy. Transanastomotic external stents were used for biliary and pancreatic drainage. Histopathologic examination confirmed foci of cholangiocarcinoma arising from BP. Resection margins were negative. Lymph node metastasis, microvascular invasion, perineural invasion, and mucin secretion were absent. The patient was discharged on postoperative day 14 without complications. At the 2-year follow-up assessment, he was alive and free of disease.
Conclusion
Cholangiocarcinoma arising from BP is a proper indication for hepatopancreatoduodenectomy. The long-term oncologic benefits might outweigh the possible perioperative complications.
5
,
6</description><subject>Aged</subject><subject>Bile</subject><subject>Bile Duct Neoplasms - diagnostic imaging</subject><subject>Bile Duct Neoplasms - surgery</subject><subject>Bile ducts</subject><subject>Bile Ducts, Extrahepatic - diagnostic imaging</subject><subject>Bile Ducts, Extrahepatic - surgery</subject><subject>Bile Ducts, Intrahepatic - diagnostic imaging</subject><subject>Bile Ducts, Intrahepatic - surgery</subject><subject>Cholangiocarcinoma</subject><subject>Cholangiocarcinoma - diagnostic imaging</subject><subject>Cholangiocarcinoma - surgery</subject><subject>Cholangiopancreatography, Magnetic Resonance</subject><subject>Cholecystectomy</subject><subject>Computed tomography</subject><subject>Hepatectomy</subject><subject>Hepatobiliary Tumors</subject><subject>Humans</subject><subject>Implants</subject><subject>Jaundice</subject><subject>Lymph nodes</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Metastases</subject><subject>Microvasculature</subject><subject>Morbidity</subject><subject>Mucin</subject><subject>Mucosa</subject><subject>Oncology</subject><subject>Pancreas</subject><subject>Pancreaticoduodenectomy</subject><subject>Papilloma</subject><subject>Papilloma - diagnostic imaging</subject><subject>Papilloma - surgery</subject><subject>Precancerous Conditions - diagnostic imaging</subject><subject>Precancerous Conditions - surgery</subject><subject>Surgery</subject><subject>Surgical drains</subject><subject>Surgical Oncology</subject><subject>Tomography, X-Ray Computed</subject><subject>Tumors</subject><subject>Ultrasonography</subject><subject>Ultrasound</subject><subject>Wound drainage</subject><issn>1068-9265</issn><issn>1534-4681</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kMtOwzAQRS0EolD4ARbIEuuAn4mzhAooUhFIdG-5sdO6SuJgO4v-PS4psGM1rzt3RgeAK4xuMWH8LmDEKMsQQRkSlBcZPgJnmKcWywU-TjnKRVaSnE_AeQhbhHBBET8FE0oIE7QQZ6Cem15F16uu8iYlenDadKaKrt3B2nn4OjTR1q5SDZxtXKO6tU2Fr2znWgVtB-PGwA8To-3W0NXwwTZW-R18V71tmqSJLthwAU5q1QRzeYhTsHx6XM7m2eLt-WV2v8gqykjMjFgxqjSpucJKoFwrojQmlOdcIJFGWCBaYFxwUqpS1UwVmhU6R2WpaZ7TKbgZbXvvPgcToty6wXfpoiSMIoGLPYIpIKOq8i4Eb2rZe9umpyVGck9WjmRlIiu_yUqclq4P1sOqNfp35QdlEtBRENKoWxv_d_sf2y_efoSf</recordid><startdate>20200901</startdate><enddate>20200901</enddate><creator>Iacono, Calogero</creator><creator>De Bellis, Mario</creator><creator>Ruzzenente, Andrea</creator><creator>Campagnaro, Tommaso</creator><creator>Conci, Simone</creator><creator>Guglielmi, Alfredo</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope></search><sort><creationdate>20200901</creationdate><title>Hepatopancreatoduodenectomy for Multifocal Cholangiocarcinoma in the Setting of Biliary Papillomatosis</title><author>Iacono, Calogero ; De Bellis, Mario ; Ruzzenente, Andrea ; Campagnaro, Tommaso ; Conci, Simone ; Guglielmi, Alfredo</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c342t-e8b43ad2f5a1a806da2ad12356580843a18037117529a9af4a7d47d6099d3663</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Aged</topic><topic>Bile</topic><topic>Bile Duct Neoplasms - diagnostic imaging</topic><topic>Bile Duct Neoplasms - surgery</topic><topic>Bile ducts</topic><topic>Bile Ducts, Extrahepatic - diagnostic imaging</topic><topic>Bile Ducts, Extrahepatic - surgery</topic><topic>Bile Ducts, Intrahepatic - diagnostic imaging</topic><topic>Bile Ducts, Intrahepatic - surgery</topic><topic>Cholangiocarcinoma</topic><topic>Cholangiocarcinoma - diagnostic imaging</topic><topic>Cholangiocarcinoma - surgery</topic><topic>Cholangiopancreatography, Magnetic Resonance</topic><topic>Cholecystectomy</topic><topic>Computed tomography</topic><topic>Hepatectomy</topic><topic>Hepatobiliary Tumors</topic><topic>Humans</topic><topic>Implants</topic><topic>Jaundice</topic><topic>Lymph nodes</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Metastases</topic><topic>Microvasculature</topic><topic>Morbidity</topic><topic>Mucin</topic><topic>Mucosa</topic><topic>Oncology</topic><topic>Pancreas</topic><topic>Pancreaticoduodenectomy</topic><topic>Papilloma</topic><topic>Papilloma - diagnostic imaging</topic><topic>Papilloma - surgery</topic><topic>Precancerous Conditions - diagnostic imaging</topic><topic>Precancerous Conditions - surgery</topic><topic>Surgery</topic><topic>Surgical drains</topic><topic>Surgical Oncology</topic><topic>Tomography, X-Ray Computed</topic><topic>Tumors</topic><topic>Ultrasonography</topic><topic>Ultrasound</topic><topic>Wound drainage</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Iacono, Calogero</creatorcontrib><creatorcontrib>De Bellis, Mario</creatorcontrib><creatorcontrib>Ruzzenente, Andrea</creatorcontrib><creatorcontrib>Campagnaro, Tommaso</creatorcontrib><creatorcontrib>Conci, Simone</creatorcontrib><creatorcontrib>Guglielmi, Alfredo</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><jtitle>Annals of surgical oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Iacono, Calogero</au><au>De Bellis, Mario</au><au>Ruzzenente, Andrea</au><au>Campagnaro, Tommaso</au><au>Conci, Simone</au><au>Guglielmi, Alfredo</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Hepatopancreatoduodenectomy for Multifocal Cholangiocarcinoma in the Setting of Biliary Papillomatosis</atitle><jtitle>Annals of surgical oncology</jtitle><stitle>Ann Surg Oncol</stitle><addtitle>Ann Surg Oncol</addtitle><date>2020-09-01</date><risdate>2020</risdate><volume>27</volume><issue>9</issue><spage>3356</spage><epage>3357</epage><pages>3356-3357</pages><issn>1068-9265</issn><eissn>1534-4681</eissn><abstract>Background
Hepatopancreatoduodenectomy is performed to achieve curative resection of malignant biliary tumors.
1
However, the morbidity and mortality associated with this challenging surgical procedure remain high, and optimal indications remain unclear.
2
–
4
Biliary papillomatosis (BP) is a precursor lesion of cholangiocarcinoma. This video shows hepatopancreatoduodenecomy for multifocal cholangiocarcinoma in the setting of BP.
Patient
A 75-year-old man with a medical history of cholecystectomy presented with obstructive jaundice. Magnetic resonance colangiopancreatography and computed tomography scan showed diffuse biliary dilation with mild enhancing nodularities in the whole extrahepatic bile duct. Cholangioscopy with biopsies proved cholangiocarcinoma arising from BP at the prepapillary common bile duct (CBD) and the biliary confluence. The second-order right ducts were free of disease. The patient underwent nasobiliary drainage and was considered for hepatopancreatoduodenecomy.
Technique
A right subcostal incision was performed. Intraoperative ultrasound showed BP of the intrapancreatic CBD spreading only to the left bile duct. En bloc resection of the left liver, caudate lobe, and CBD was performed together with pylorus-preserving pancreatoduodenectomy. The reconstruction phase was performed on a single-loop by duct-to-mucosa pancreatojejunostomy, two-duct biliojejunostomy with mucosa-to-mucosa alignment, and duodenojejunostomy. Transanastomotic external stents were used for biliary and pancreatic drainage. Histopathologic examination confirmed foci of cholangiocarcinoma arising from BP. Resection margins were negative. Lymph node metastasis, microvascular invasion, perineural invasion, and mucin secretion were absent. The patient was discharged on postoperative day 14 without complications. At the 2-year follow-up assessment, he was alive and free of disease.
Conclusion
Cholangiocarcinoma arising from BP is a proper indication for hepatopancreatoduodenectomy. The long-term oncologic benefits might outweigh the possible perioperative complications.
5
,
6</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>32248378</pmid><doi>10.1245/s10434-020-08357-1</doi><tpages>2</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1068-9265 |
| ispartof | Annals of surgical oncology, 2020-09, Vol.27 (9), p.3356-3357 |
| issn | 1068-9265 1534-4681 |
| language | eng |
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| source | MEDLINE; SpringerNature Journals |
| subjects | Aged Bile Bile Duct Neoplasms - diagnostic imaging Bile Duct Neoplasms - surgery Bile ducts Bile Ducts, Extrahepatic - diagnostic imaging Bile Ducts, Extrahepatic - surgery Bile Ducts, Intrahepatic - diagnostic imaging Bile Ducts, Intrahepatic - surgery Cholangiocarcinoma Cholangiocarcinoma - diagnostic imaging Cholangiocarcinoma - surgery Cholangiopancreatography, Magnetic Resonance Cholecystectomy Computed tomography Hepatectomy Hepatobiliary Tumors Humans Implants Jaundice Lymph nodes Male Medicine Medicine & Public Health Metastases Microvasculature Morbidity Mucin Mucosa Oncology Pancreas Pancreaticoduodenectomy Papilloma Papilloma - diagnostic imaging Papilloma - surgery Precancerous Conditions - diagnostic imaging Precancerous Conditions - surgery Surgery Surgical drains Surgical Oncology Tomography, X-Ray Computed Tumors Ultrasonography Ultrasound Wound drainage |
| title | Hepatopancreatoduodenectomy for Multifocal Cholangiocarcinoma in the Setting of Biliary Papillomatosis |
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