Surgical Treatments for Hepato-Pancreato-Biliary (HPB) Cancers

Hepato-pancreato-biliary cancers, otherwise known as HPB cancers, are cancers that can affect either the liver (hepato), pancreas (pancreato), gall bladder or bile ducts (biliary).

Liver cancer, pancreatic cancer, gall bladder cancer and bile duct cancer are complex diseases to treat due to a delay in patients showing symptoms, meaning that the disease has progressed to an advanced stage by the time they are diagnosed. However, due to significant advancements in the availability of treatment options in recent years, treating these types of tumors with the hope of cure is more in reach.

Surgery for HPB cancers

Treating HPB cancer requires a multidisciplinary team approach, which includes a variety of specialized experts such as surgical, medical and radiation oncologists, interventional radiologists and specialized radiologists, pathologists and nursing caregivers.

If HPB cancer is diagnosed at an early stage, surgery can offer a cure depending on the type and stage (how far has the cancer progressed). However, surgery for this group of cancers remains challenging, due to the complexity of the anatomical structures involved in HPB cancers and their aggressive nature.

Having access to a comprehensive range of surgical and locoregional treatment options is key. This ranges from minimally invasive options such as microwave ablation and radiology intervention techniques, to the most invasive surgeries, such as liver resection and transplantation. The availability of liver resection and transplantation for eligible patients with advanced disease is very promising as these patients were historically considered incurable.

The decision to go-ahead with HPB cancer surgery will be carefully considered based on many factors including a thorough evaluation of the tumor's characteristics, its spread, and the patient's overall health and ability to withstand the procedure.

Learn more about innovations in HPB cancer diagnostics and treatments here.

Minimally Invasive Surgery for HPB Cancers

If the best option for your cancer is surgery, specialized surgical oncologists and surgeons may offer a minimally invasive approach such as robotic surgery.

This technology involves making small incisions instead of traditionally large ones, resulting in benefits to patients such as reduced blood loss, shorter hospital stays, faster recovery times and less scarring. It is important to note that minimally invasive surgery may not be a suitable option for every patient.

Surgical options for HPB cancers are outlined below.

Liver cancer surgery

Surgery to treat liver cancer will depend on certain factors, including overall health and the stage of the cancer. Surgical options include:

• Liver resection or partial hepatectomy: The goal of a liver resection is to remove the area of the liver that contains the cancer. The diseased portion of the liver is removed with enough space around its edges to ensure all the cancer is removed. The liver’s ability to regenerate (regrow) makes this possible.
• Liver Transplant: If the cancer is confined to the liver, but not suitable for resection, then the whole liver may be removed (total hepatectomy) and replaced with the donor liver (a liver transplant).

Only some patients will be candidates for liver resection and transplant.

Pancreatic cancer surgery

Surgical options to treat cancer of the pancreas include:

• Whipple procedure: Also called a pancreaticoduodenectomy, this procedure is commonly used for cancers found at the head of the pancreas. It involves removing the head of the pancreas, as well as parts of the stomach, small intestine, gallbladder, and bile duct.
• Distal pancreatectomy: Performed when cancer is present in the tail or body of the pancreas, the procedure involves removing the tail and sometimes a section of the pancreas body.
• Total pancreatectomy: The entire pancreas is removed, along with part of the stomach, part of the small intestine, and the gallbladder, bile duct, spleen, and nearby lymph nodes.

Gallbladder cancer surgery

Surgical options for patients with gallbladder cancer include:

• Cholecystectomy: During this procedure, the gallbladder is removed.
• Extended cholecystectomy: As well as the gallbladder, part of the liver, bile ducts and lymph nodes are removed during this procedure.

Bile duct cancer surgery

Surgical options for patients with cancer of the bile duct include:

• Bile duct/liver resection: The cancerous parts of the bile duct and segments of the liver are removed.
• Pancreatic resection: If the part of the bile duct that passes into the pancreas is cancerous, then this procedure may be performed.
• Liver transplant: If the cancer is advanced and not treatable with conventional surgery, then a liver transplant may be required.