Hepato-pancreato-biliary (HPB) surgery, more commonly referred to as hepatobiliary surgery, focuses on advanced, minimally-invasive and open surgical techniques to treat cancer and diseases of the liver, pancreas, bile duct and gall bladder. It involves the removal (resection) of primary and metastatic tumors in these organs. It is also used to treat benign diseases such as cysts, lesions, bile duct injuries, gallstones and portal hypertension. As one of the most complex surgical procedures, hepatobiliary surgery calls for a great degree of skill and precision.

Conditions treated

Liver

  • Hepatocellular carcinoma
  • Metastatic liver cancers (colorectal, neuro-endocrine, etc.)
  • Intrahepatic cholangiocarcinoma
  • Liver cysts and polycystic disease
  • Hemangiomas
  • Focal nodular hyperplasia
  • Hepatic adenoma

Pancreas

  • Pancreatic cancer
  • Pancreatic neoplasms (IPMN, mucinous cystadenoma)
  • Neuroendocrine tumors (insulinoma, carcinoid tumors, glucagonoma, VIPoma, etc)
  • Chronic pancreatitis
  • Pancreatic cysts and pseudocysts

Biliary System  (Bile Ducts and Gallbladder)

  • Bile duct cancers (hilar cholangiocarcinoma/Klatskin tumors)
  • Bile duct injury
  • Gallbladder cancers

Causes

Depending on the type of disease involved, causes may vary that lead to a need for hepatobiliary surgery. Diseases of the liver and biliary system can be caused by viral, bacterial and parasitic infections, neoplasia, toxic chemicals, alcohol consumption, poor nutrition, metabolic disorders, and cardiac failure. The two predominant diseases of the liver in the United States are viral hepatitis and cirrhosis; the predominant chronic disease of the biliary system is cholelithiasis.

Tests

Tumors in the liver typically are diagnosed with CT or MRI scans of the abdomen, or blood work. Although these tests could be enough to determine the type of liver tumor, patients could also require a biopsy to confirm the diagnosis. Pancreas, bile duct and gallbladder tumors also require CT and MRI scans to make the initial diagnosis. Sometimes endoscopy is needed to pinpoint the exact problem.

Treatment options

Liver, pancreas and biliary cancers, while relatively rare, are aggressive and generally associated with poor outcomes. Most of these patients require multidisciplinary specialty care for successful treatment with emphasis on aggressive surgical care. Highly-specialized surgical options, such as those offered at Methodist Transplant and Specialty Hospital, can offer the possibility of a cure for these types of malignancies.