Liver, Pancreatic and Bile Duct Surgery

We perform laparoscopic surgery using minimally invasive techniques whenever possible. That means potentially less pain, less blood loss and reduced need for blood transfusions. Laparoscopic surgery could also mean a shorter hospital stay, with a quicker recovery and faster return to normal daily activities. However, there are potential downsides of laparoscopic surgery as well. In addition, not everybody is a candidate for laparoscopic HPB surgery. Tumor size, location, previous medical and surgical history all weigh into this decision making process. Your candidacy for laparoscopic procedures is discussed with you by your surgeon in details.

Up to about 20% of patients with pancreas surgery performed for the removal of pancreas cancer undergo vein resection for close proximity or direct venous involvement of a critical vascular structure by the tumor. Most of these patients are considered to have locally advanced disease and undergo neoadjuvant therapy prior to definitive surgery. Following completion of neoadjuvant therapy restaging is done to determine response of the tumor to upfront therapy. Our surgical oncologists have extensive experience performing vascular resections in the setting of locally advanced pancreas tumors.

Most operations performed for HPB malignancies are complex surgeries (see list above). Our number one priority is to perform these operations safely with outcomes comparable to any major cancer center in the US. The details of your surgery will be discussed with you by your surgical oncologist prior to any operation. Our surgical oncologists have extensive experience with these complicated procedures.

Each patient is different, and so could be their postoperative course. We have standardized postoperative pathways for major HPB surgeries. Most patients should expect to spend 5-10 days in the hospital. Several patients get an epidural catheter inserted prior to surgery. Most patients come out of the operating room with various tubes and drains inserted during surgery. Patients maybe observed in the ICU for a day or two even if everything goes well. From the ICU, patients are transferred to either a stepdown unit or a surgical floor. We will help and encourage you to get out of bed as soon as possible to reduce the chance of blood clots infections and to make you feel better. We will advance your diet depending on how you tolerate liquids. Most patients are seen by a nutritionist after surgery as well. Patients have to meet standardized criteria prior to discharge. It will take several weeks to months to completely recover from surgery. You will likely be able to return to work, at least part time, before you completely recover.

Adjuvant or postoperative chemotherapy/radiotherapy are frequently used. Indications for adjuvant therapies are discussed with each patient individually after a finalized pathology report is available and pathologic staging is done. Adjuvant therapies are administered following current standards in the treatment of HPB malignancies. We let patients recover from surgery prior to the administration of any adjuvant therapy.