The care of patients with Liver, Pancreas and Bile Duct disease requires multiple disciplines. To make sure our patients have the best outcomes, each patient’s case is discussed among our team of dedicated physicians at weekly conferences. Our team includes a Liver, Pancreas and Biliary Surgery, Hepatology, Interventional Endoscopy, Interventional Radiology, Gastroenterology, Medical Oncology, Radiation Oncology, and an expert Radiologist in body imaging.
Patients challenged with the most complex illnesses receive multidisciplinary care for medical oncologists, hepatologists, gastroenterologists, radiologists, and interventional radiologists. This balanced approach provides comprehensive care to patients and the best results possible.
As liver, pancreas and biliary surgery push into new frontiers, so does the technology needed to plan these complex procedures. Whether laparoscopic or open surgery, every possible detail of the patient’s care is analyzed to ensure surgery is safe and effective. 3D reconstructed imaging is used to plan your surgery. No aspect of your care is taken for granted.
Liver cancers either start in the liver or spread (metastasize) to the liver from another site. The most common cancer that starts in the liver is hepatocellular cancer (HCC or hepatoma). The most common cancers that spread to the liver that can be surgically removed are from the colon and rectum. Neuroendocrine tumors/cancers from the pancreas and intestine also can be surgically removed from the liver with good long term survival. Other cancers that spread to the liver that can be treated with surgery are ovary, uterus, germ cell, prostate, kidney, stomach, and melanoma.
Early diagnosis of a hepatoma (also called primary liver cancer, hepatocellular cancer, or HCC) gives the best chance of long term survival. Patients needing routine liver cancer surveillance are: 1) all patients with cirrhosis, and 2) patients with hepatitis B infection and detectable virus growing in their blood. The most common causes of cirrhosis in the United States are hepatitis C and/or B infection, alcohol overuse, and fatty liver. Unfortunately, 7 out of 10 patients with liver cancer have advanced cancer when found and will not benefit from surgical removal or liver transplant.
Because liver cancer usually occurs with cirrhosis of the liver, only 1 out of 10 patients are eligible for surgical removal. In patients with early cirrhosis, surgery can be used when the patient has normal liver chemistries, a normal platelet count, and no evidence of portal hypertension. Most liver surgery for removal of liver cancer can be performed laparoscopically.
Pancreas cancer remains a deadly disease. Over 9 out of 10 people with pancreas cancer will not live longer than 5 years from the time they were first diagnosed. At surgery, 4 out of 10 patient will be eligible for a curative surgical resection. Of patients surgically resected, 8 out of 10 will have have their pancreas cancer reoccur. Only 2 out of 10 patients surgically resected for cure will be alive 5 years after surgery.
Any patient with pancreas cancer should strongly consider enrolling in a clinical trial.
At the National Cancer Institute patient treatment information web site, clinical trials listed are possible treatment options for patients with pancreas cancer.
Injury from cholecystectomy: Injury to the common bile duct during laparosopic cholecystectomy occurs in 1 in 1000 patients. The type of injuries are classified as shown below. Patient’s with a bile duct injury have the best outcome when repaired by a surgeon experienced with hepato-pancreato-biliary surgery.
Cysts of the blie duct are called choledochocysts. There are several types located in different parts of the common biliary and hepatatic ducts. Over many years, there is a 10-20% chance a bile duct cancer will grow within a choledochocyts. It is generally recommended that choledochocysts be removed to avoid the risk of developing cancer.
Scaring of the common bile duct can result from stones in the gallbladder passing through the duct into the intestine.