Hepatopancreatobiliary surgery consists of surgical treatment for benign and malignant diseases of the liver, pancreas, gallbladder, and bile ducts. These are among the most challenging and complex surgical procedures performed in General Surgery and require a high degree of expertise and skill.
Types of Diseases
Liver Tumors – Tumors of the liver can be either primary liver cancers or liver metastases from other sites in the body. The most common tumor to metastasize to the liver is colorectal cancer. Another type of tumor that metastasizes to the liver is a neuroendocrine tumor of the gastrointestinal tract.
Pancreas Tumors – Cancers of the pancreatic duct are the most common but patients can develop neuroendocrine tumors of the pancreas as well as cystic tumors that can either be precancerous or malignant upon presentation.
Gallbladder and bile duct Tumors – These types of cancers are relatively rare but when found can require extensive surgery to treat.
Liver tumors typically present with nonspecific abdominal symptoms and are found with CT or MRI scan of the abdomen. Sometimes a biopsy may be needed to confirm the diagnosis but often just the imaging and blood work can determine the exact type of liver tumor.
Pancreas, gallbladder, and bile duct tumors can present with painless jaundice or also vague abdominal symptoms. They also require CT or MRI imaging make the initial diagnosis. Sometimes other tests such as endoscopy may be needed to make the diagnosis or to relieve bile duct obstruction due to tumor.
The treatment of patients with hepatopancreatobiliary tumors is facilitated by a multidisciplinary conference which meets regularly to discuss new patients and formulate a treatment plan. Those present include: your surgeon, medical oncologist, interventional radiologist, and radiation oncologist and people from diagnostic radiology and Nursing.
Liver Tumors – Primary liver cancer can only be cured with resection or liver transplantation. Metastatic colorectal cancer to the liver can only be cured with complete surgical removal of all disease. Sometimes ablative therapy (using heat and radio waves destroy tumor cells) is used in conjunction with resection or when the patient’s tumor is not operable with conventional surgery. Minimally invasive techniques are also being used to remove liver tumors with smaller incisions and this may help with postoperative recovery and reduce the incidence of wound infection.
Pancreas Tumors – Surgical removal of pancreatic malignancies is the only chance for cure. If the tumor is located in the head (figure of pancreas anatomy) of the pancreas a Whipple resection may be necessary with possible blood vessel reconstruction if needed. For tumors located in the body and tail of the pancreas minimally invasive techniques can be used with similar benefits as in liver surgery.
Gallbladder and bile duct Tumors – Besides liver resection being the treatment of choice for these tumors, often patients may need their bile duct reconstructed depending on the degree of tumor involvement or if the bile duct is blocked by tumor.