Liver, Pancreas, Biliary Diseases

Liver cancer- Most commonly includes hepatocellular carcinoma (HCC) and liver metastasis from the colon or rectal cancers. Intrahepatic cholangiocarcinoma is now being commonly seen. Most common symptoms are fatigue, loss of appetite and weight loss. Liver cancers are mostly diagnosed with triple contrast CT scan of the abdomen. In most patient’s surgery offers long term relief. The most commonly performed surgery is partial excision of the liver called right or left hepatectomy. In cases where cancer is limited to a left lateral segment of the liver, a left lateral segmental excision of the liver is performed laparoscopically with excellent results. In most cases of liver metastasis, we do laparoscopic metastasectomy. Even with the removal of 60% of the liver, the liver regains its normal volume within 2 weeks, so a major liver resection of 60% can be done safely in most patients. In cases where surgery cannot be performed initially the option is to give TACE (transarterial chemoembolization) initially which shrinks the tumour followed by surgical excision.

Disorders of the biliary system

Surgical management of complicated benign biliary disorders is done by biliary reconstructive procedures (Hepaticojejunostomy). Laparoscopic gall bladder surgery with intraoperative cholangiogram and ERCP in conjunction with medical gastroenterology helps in the management of gall bladder and CBD stone simultaneously. Roux en Y hepaticojejunostomy is done for benign benign biliary stricture (BBS)

Bile duct cancers (cholangiocarcinoma)

Is being increasingly seen. It is predisposed in patients with a choledochal cyst of the bile duct, primary sclerosing cholangitis (PSC), ulcerative colitis etc. Symptoms are similar to gall bladder cancer except that jaundice is seen in the early course of the disease. Bile duct starts from the liver and ends into the pancreas. Upper-end cholangiocarcinoma behaves as liver cancer and lower end behaves as pancreatic cancer. Surgery offers long term relief in patients where it is performed earlier. We at our centre do whipple PD (pancreaticoduodenectomy) for lower bile duct cancers and local excision for mid-CBD tumour. Cholangiocarcinoma invading unilateral secondary biliary radicle we perform a standard right or left hepatectomy.  

Gall bladder cancers (GBC)

Long-standing gall stones predispose to GBC. Symptoms are mostly continuous pain right upper abdomen, weight loss, loss of appetite. In patients were gall bladder cancer present with jaundice its usually an advanced stage. Stage of disease is best assessed with MRI/ CT of the abdomen and at times PET scan is required. Intraoperative ultrasound helps in decision making for the margin of excision. Surgery is the best treatment modality for GBC. Most commonly performed the surgery at our centre is laparoscopic/ open extended cholecystectomy with hepatoduodenal lymph node dissection. CBD excision with hepaticojejunostomy is at times necessary to obtain a negative margin.  Surgery offers excellent long term relief in patients with early-stage of disease.

Pancreas

We have a high volume unit for pancreatic surgery with results being comparable with the best centres in the world. Surgical management of chronic pancreatitis and pancreatic stones are done with excellent results.

Video-assisted retropertoneal debridement (VARD) is done for Walled of  Necrotisisng panacreatitis (WOPN)

Chronic Pancreatitis and Pancreatic stone surgery- freys procedure

Pancreatic Pseudocyst- laparoscopic cystogastrostomy

Pancreatic and periampullary cancers

The most common symptoms of pancreatic cancer are loss of appetite, jaundice and weight loss. Diagnosis is usually established with a triple-phase CECT abdomen. The management of pancreatic cancer depends on the location of the tumour in pancreas and stage of the disease. If the tumour is located in head Whipple pancreatic oduodenectomy surgery is required. For tumours located in the tail of pancreas, distal pancreatectomy with splenectomy is usually required. We do central pancreatectomy for tumours located in the midbody of the pancreas, thereby minimizing removal of normal pancreas. In cases where the stage of the disease is early and surgery is performed in the early course of treatment, the prognosis is usually good.