无癌切除（R0）是胆管癌长期生存的最重要因素之一。对于一些位于肺门和胰内胆管之间的广泛浸润癌的患者，肝胰十二指肠切除术（HPD）被认为是R0切除的根治性手术。然而，HPD 与高发病率和死亡率相关。此外，之前的报道并未显示淋巴结转移（LNM）状态，例如位置或数量，这可能会影响 HPD 后的预后。在本研究中，首先，我们探讨了生存的预后因素，其次，我们评估了 LNM 状态（LNM 的数量和位置）是否会影响广泛传播的胆道恶性肿瘤患者的手术指征决策。 2003 年 1 月至 2021 年 12 月期间，54 名在≥2 个肝区接受 HPD 肝切除术的患者的记录 (HPD-G)。我们还评估了 2010 年 1 月至 2021 年 12 月接受化疗 (CTx-G) 的 54 名不可切除的肝门周围胆管癌患者。其中 48 名患者 (89%) 进行了 R0 切除。 HPD-G组和CTx-G组的中位生存时间（MST）和5年总生存率分别为36.9个月和31.1%，以及19.6个月和0%。单变量和多变量分析显示，病理性门静脉受累是生存的独立预后因素（MST：18.9 个月）。此外，胰周 LNM 患者的预后（MST：13.3 个月）比 CTx-G 更差。胰周 LNM 或 PV 侵犯的患者可能会被建议排除在 HPD 的手术优先适应症之外。© 2023。外科肿瘤学会。

Cancer-free resection (R0) is one of the most important factors for the long-term survival of biliary carcinoma. For some patients with widespread invasive cancer located between the hilar and intrapancreatic bile duct, hepatopancreaticoduodenectomy (HPD) is considered a radical surgery for R0 resection. However, HPD is associated with high morbidity and mortality rates. Furthermore, previous reports have not shown lymph node metastasis (LNM) status, such as the location or number, which could influence the prognosis after HPD. In this study, first, we explored the prognostic factors for survival, and second, we evaluated whether the LNM status (number and location of LNM) would influence the decision on surgical indications in patients with widely spread biliary malignancy.We retrospectively reviewed the medical records of 54 patients who underwent HPD with hepatectomy in ≥2 liver sectors from January 2003 to December 2021 (HPD-G). We also evaluated 54 unresectable perihilar cholangiocarcinoma patients who underwent chemotherapy from January 2010 to December 2021 (CTx-G).R0 resection was performed in 48 patients (89%). The median survival time (MST) and 5-year overall survival rate of the HPD-G and CTx-G groups were 36.9 months and 31.1%, and 19.6 months and 0%, respectively. Univariate and multivariate analyses showed that pathological portal vein involvement was an independent prognostic factor for survival (MST: 18.9 months). Additionally, patients with peripancreatic LNM had worse prognoses (MST: 13.3 months) than CTx-G.Patients with peripancreatic LNM or PV invasion might be advised to be excluded from surgery-first indications for HPD.© 2023. Society of Surgical Oncology.