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HPB Surgery

HPB Surgery

What is HPB?

HPB means diseases of the Liver (Hepato) Pancreas (P) and Biliary system (gall bladder and bile duct).

What does the department of HPB do?

We investigate and treat all benign (Non-cancerous) and malignant (cancer) diseases of the above organs.

What is liver cancer?

Cancer of the liver can be of two types: Primary and Secondary. Primary cancers are the ones that originate from the liver and secondary cancers are the ones that have spread to the liver.

What is the incidence of primary liver cancers?

They are generally seen in patients suffering from cirrhosis of the liver. Some of the risk factors for cirrhosis are Alcohol, Hepatitis B, Hepatitis C, diabetes and fatty liver.

Primary liver cancer is the fifth most common cancer in the world and the third most common cause of cancer mortality. Incidence increases with age. If left untreated, 5 year survival rate is approximately 7%. Worldwide, approximately 100/100,000 people suffer from some form of liver cancer; one of the commonest regions being India.

What is the incidence of secondary liver cancers?

Around 50% of patients with intestinal cancer will develop cancer spread to the liver (An Annual incidence of 1 lakh patients India). Besides all other cancers like breast, pancreas, ovarian can also spread to the liver.

What is the incidence of pancreatic cancer?

The life time risk of getting pancreatic cancer is 1 in 71 (1.41%). Twenty two people die every day from pancreatic cancer. Only 10% are diagnosed in time for potentially curative surgery. Five year survival following surgical removal is 35 %. Without an operation, the five year survival is 0%.

What are the risk factors for pancreatic cancer?

Elderly people (age >60 years), chronic pancreatitis, obesity, diabetes and family history of pancreatic cancer are the risk factors associated with pancreatic cancer.

What are the symptoms and signs of cancer of the liver and pancreas?

Most patients would present with the following:

  • Pain in abdomen
  • Jaundice
  • Unexplained
  • Weight loss
  • Abdominal distension
  • Fatigue

How do you detect HPB cancers?

Majority of the HPB cancers are detected with the help of a CT scan and certain blood cancer markers. In addition, some of the patients will need to undergo additional MRI scan. Patients with pancreatic cancers may need to undergo an Endoscopic ultrasound in order to stage the disease and undergo a biopsy.

Why is it important to detect these cancers early?

If you have any of the above symptoms and have one of the risk factors, it is essential to get investigated as soon as possible in order to detect it early. As mentioned before, only a small proportion of patients are deemed to have a cancer that can be cured completely by surgical resection. Generally, only 30-40% of liver cancers, and only 10-15% of pancreatic cancers can be operated, once diagnosed.

Is surgery the only curative option?

Yes, the majority of liver and pancreatic cancers can be cured only by an operation.

Is an open surgey the only option?

No, at our hospital, we have surgeons who are trained in Minimally Invasive (Laparoscopic and Robotic) Surgery (MIS). The advantages of MIS are smaller incisions, better pain relief and early recovery. However, the team will discuss and decide on the best possible treatment for every individual patient.

What are the other treatment options in liver cancer (if surgery is not possible)?

There are a few options like Chemotherapy, Radiofrequency Ablation (RFA) (burning of liver tumours with special needles), Transarterial Chemo-Embolisation (TACE) (special technique to give directed chemotherapy). Most patients with cirrhosis of the liver will need a liver transplant if the cancer is restricted to the liver.

What are the other treatment options in pancreatic cancer (if surgery is not possible)?

It is common to find pancreatic cancers that are at an advanced stage and may not be able to undergo any form of surgery. The only other alternative options that are available are Chemotherapy and Radiotherapy. Both are palliative in intent and cannot cure the disease.

Why should we get treated at kokilaben dhirubhai ambani hospital?

At our hospital, we have a dedicated unit of HPB and Liver Transplant Surgery which can take care of all HPB cancers. We have a team of trained surgeons, therapeutic endoscopist (for EUS and ERCP), oncologists (for chemotherapy), radiotherapist and interventional radiologist (for RFA and TACE). All the doctors' work as a team and every patient is discussed at the multidisciplinary team meeting, in order to provide the best possible treatment to an individual patient.

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