Hepatopancreatobiliary surgery implies surgical treatments for benign and malignant diseases of liver, pancreas, gall bladder and bile ducts. These are difficult and complex General Surgery procedures that require experience and skill.
Liver tumors not only originate from the liver, but they may also spread (metastasize) from a tumor that is located in any other body part to the liver. Majority of hepatic metastases arise out of a tumor located in colon and rectum. Another source is neuroendocrine tumors of gastrointestinal tract.
Neuroendocrine tumors and cystic tumors with benign or malignant prognosis depending on the type may be the cause of pancreatic tumors along with the pancreatic canal.
Gall bladder and bile duct tumors require extensive surgical procedure, although such cancers are rare.
Diagnosis
The liver tumors may show signs of presence with abdominal pain and generally identified during CT or MRI scans. Biopsies may be required in some cases to verify diagnosis. However imaging and blood test results allow us to predict the type of tumor with near perfect precision.
Tumors of pancreas, gall bladder and bile duct may occur with symptoms of jaundice that does not associate with pain or ambiguous abdominal signs. CT or MRI is necessary for provisional diagnosis. In some cases procedures such as endoscopy are applied for diagnosis or treatment of congestion secondary to tumor.
Treatment
Treatment of hepatopancreatobiliary tumors is discussed and planned with multidisciplinary approach. This multidisciplinary structure consists of a hepatobiliary surgeon, medical oncologist, interventional radiologist, radiation oncologist and physicians from diagnostic radiology.
Liver tumors; cure of primary liver cancers is only possible with resection (extraction of the tumor with a clear surgical margin) or transplantation. Metastatic colorectal cancers require complete resection of the diseased part for treatment. If complete surgical extraction of the tumor is not possible, ablative treatments (destruction of tumor cells with heat and radio waves) can be used in addition to resection and residual tumoral tissues can be cleared with this method. In addition to known open surgery, resection of the tumor is also possible with minimally invasive (laparoscopic) methods. Benefits of minimally invasive approach include shorter recovery period and lower wound infection risk.
Pancreas Tumors; the only chance of cure in pancreas cancer cases is surgery. Extraction of the tumor such that only clear surgical margins are left behind yields the best results. Whipple operation, with vessel reconstruction when required, is performed if the tumor is located in head section of pancreas. Resection with the spleen or while preserving spleen can be performed depending the type of the tumor if the tumors are located in corpus or tail sections.
Gall bladder and Bile Duct Tumors; liver resection is also frequently used in these types of tumors. The congestion in bile ducts caused by the tumor may require reconstruction of the bile ducts in various degrees depending on the severity of congestion.
