Hepatopancreaticobiliary Surgery Program

Hepatopancreaticobiliary surgery

At AHN, we take pride in offering minimally invasive techniques when available and all-encompassing approaches when needed.

Laparoscopic robotic assisted surgeries

In some cases, laparoscopic or hand-assisted surgery can be used to perform a liver resection, or a removal of part of the liver. The surgeons will review your case and decide whether it may be possible, safe, and effective to perform your surgery in this way. It allows for smaller incisions and a more rapid recovery. We are now able to offer this type of surgery in approximately 50% of liver resection cases.Specific surgeries we do include robotic assisted:

• Laparoscopic liver resection for cancerous and noncancerous liver lesions
• Laparoscopic pancreas and spleen resections
• Laparoscopic cholecystectomy
• Laparoscopic liver cyst fenestration
• Laparoscopic enucleation of noncancerous liver tumors

Traditional and open liver surgery

Some patients require more complex surgical planning and are unable to undergo minimally invasive surgery. Often this means a patient will undergo:

• Open liver resections: This involves surgically removing a portion of the liver through a traditional incision, typically to remove tumors or damaged tissue.
• Two-stage hepatectomies: This is a procedure done in two stages to remove large tumors of the liver. The first stage redirects blood flow to help the liver grow, and the second stage involves removing the tumor. Learn more about hepatectomy procedures.
• Whipple procedures: Also known as a pancreaticoduodenectomy, this complex surgery removes the head of the pancreas, the first part of the small intestine (duodenum), the gallbladder, and part of the bile duct to treat pancreatic cancer and other disorders. Learn more about Whipple procedures to understand what this complex surgery fully entails.
• Hepaticojejunostomies: By creating a connection between the bile ducts and small intestine (jejnum), blockages and damage are bypassed so bile can flow freely.
  

Alternatives to surgery

Sometimes surgery is not the first and only option, and we work with specialists to give treatments before surgery. These treatments can include a combination of treatment techniques to help them on the road to liver surgery. Prior to undergoing removal of their liver cancer, another treatment modality may be used to help shrink the tumor or prepare the liver for surgery.

Chemotherapy and radiation therapy

For example, up-front chemotherapy (called “neoadjuvant”) may be performed to prime the cancer for removal or decrease the size and number of tumors that have to be taken out with surgery.

If there are too many tumors to be safely removed with surgery alone, we frequently use a combined approach with radiation oncology and stereotactic body radiation therapy (SBRT). Liver SBRT is a rapidly emerging noninvasive technique that allows for precise delivery of high doses of radiation to the tumors. In the same patient, we can use surgery to remove some liver tumors and SBRT to treat the others. This allows us to offer aggressive surgical resection to patients with multiple tumors or tumors in an unfavorable location for removal.

Embolization

In other cases, a technique called portal vein embolization (PVE) is used to grow the healthy side of the liver before surgery. This allows even patients with larger tumors to be considered as surgical candidates. A type of doctor called an interventional radiologist uses a catheter through the skin to limit the blood flow to the cancerous side of the liver. The side with the cancer then shrinks (atrophies) over three to four weeks, while the healthy side grows (hypertrophies). Surgery is then performed to remove the cancerous side and leave behind a safe amount of liver tissue for the body to function.

Another technique is called radioembolization (Y90), performed by the interventional radiology team that helps treat the tumor in addition to growing the opposite side of the liver to help with resection and or to get to transplant.

Thanks to this teamwork between specialties — and our aggressive technical approach — surgery is now an option for an increasing number of patients with cancer in the liver and bile ducts.

To find out whether you or a loved one may be eligible for these services, contact our office at 412-359-6738.

What are the complications of hepatobiliary surgery?

As with nearly every surgery, complications can happen with a hepatobiliary surgery. Your AHN team will be with you through the entire surgery and post-op to ensure all considerations are taken to aim for a complication-free experience. However, there are things that can happen, including:

• Infection: Infections at the surgical site or within the abdomen can occur, requiring antibiotics or further intervention.
• Bleeding: Bleeding can happen during or after the surgery, sometimes requiring blood transfusions or additional procedures to control it.
• Bile leak: Bile can leak from the surgical connections, leading to inflammation and requiring drainage or further surgery.
• Pancreatitis: Inflammation of the pancreas can occur, especially after procedures involving the pancreas.
• Liver failure: In rare cases, the remaining liver may not function adequately, leading to liver failure.
• Blood clots: Blood clots can form in the legs or lungs, requiring anticoagulation therapy.
• Wound healing issues: The surgical wound may have difficulty healing, leading to infection or requiring further treatment.
• Strictures: Narrowing of the bile ducts can occur, requiring intervention to open them up.

Hepatopancreaticobiliary surgery specialists

AHN surgery specialists focused on hepatopancreaticobiliary treatment are highly trained, experienced, compassionate surgeons and health care professionals who see each patient as an individual with unique needs, and tailor treatment to meet those.

Hepatopancreaticobiliary Team

Physician assistant

• Sarah Skeba, PA-C

Office coordinator

• Linda Hamilton

How to get care

Call 412-359-6738 to schedule an appointment with our Abdominal Transplant and Hepatopancreaticobiliary Surgery Division.

At your appointment, you should expect to meet with a specialist who will discuss treatment options, outcomes, and expectations. This may include reviewing your prior imaging, lab results, and pathology results. Your case may also be discussed at our multidisciplinary tumor board to confirm the treatment plan and provide the opportunity for the best possible approach. We will also address any questions you or your supporters (family, friends, etc.) may have regarding your upcoming treatment.

Clinical trials and research

Clinical trials offer eligible patients who volunteer to participate, new options for cancer treatment with novel uses of medications, radiation or surgical techniques with the goal to improve cancer treatment as a whole. You can discuss available active clinical trials with your doctor and determine your eligibility to participate. 

Currently active transplant clinical trials at AHN include:

• ARTxOnc: Liver transplant for unresectable colorectal liver metastasis.

What is a clinical trial?

Clinical trials are studies that try to answer questions about new ways to treat cancer with medications, radiation, or surgical techniques. Previous trials have shown how new methods of treatment improve survival and quality of life and reduce the risk of cancer returning.

You participate in a clinical trial only if you volunteer to do so and meet criteria for inclusion in the study, and you can stop participating in a trial at any time.

Who can join a clinical trial?

The plan for the trial, called a protocol, explains what the trial will do and how the study will be done. Based on the questions the research is trying to answer, each clinical trial protocol outlines specific criteria necessary to be eligible to join the trial.

Common criteria for entering a trial are:

• Having a certain type of medical issue or stage of cancer.
• Having received a certain kind of therapy in the past.
• Being in a certain age group.

Federal rules help ensure that clinical trials are run in an ethical manner, with your rights and safety protected. It’s to ensure that you’re not put at increased risk by participating in the trial, and that the results of the study are accurate and meaningful.

Refer your patient to an AHN specialist

There are two ways for medical professionals who are not a part of Allegheny Health Network, to refer their patients to an AHN specialist and request their first appointment. You can: 

1. Call 412-359-6738, and select Option 2.
2. Go to Find Care to find the right AHN specialist and the most convenient location. Then refer your patient, provide relevant patient details, and request an appointment directly from the doctor's profile. 

For more information about referring your patient to an AHN specialist, read the Independent Physician Referral FAQs.