Located in the upper right portion of the abdomen the liver, pancreas, gall bladder and bile duct are known as the hepatobiliary and pancreatic system. Diseases of the liver and pancreas are often complex and can lead to severe problems that can disrupt quality of life and can be life-threatening. Together, the liver, pancreas and the biliary system represent some of the most complicated anatomy in the body.
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When disease, such as cancer strikes the liver, pancreas or gallbladder, a highly complex specialised surgery known as hepatobiliary and pancreatic surgery is performed. The surgeons that carry out these procedures are called hepatobiliary and pancreatic surgeons, they have specialised training and experience in the complete management of cancerous and non-cancerous abnormalities arising in this area. Surgery to treat cancers and disorders in these organs is highly complicated and challenging and requires a high level of skill and expertise.
Dr Adeeb Majid is a specialist Hepatobiliary, Pancreatic and Upper Gastrointestinal Surgeon, he completed his general surgical training at John Hunter Hospital Newcastle and did 3 years of specialist Hepatobiliary, Pancreatic and Upper Gastrointestinal Surgery Training in Sydney and Adelaide. He also gained further experience in pancreatic surgery at Heidelberg (Germany) and in Liver surgery in Seoul. He is the only Surgeon in Hunter/Central coast area with a Fellowship of Australia and New Zealand Hepatic, Pancreatic and Biliary association (ANZHPBA).
Beyond the technical expertise necessary for safe and effective liver and biliary surgery, he works closely with a multidisciplinary team to provide an individualised treatment plan for each patient. This team of specialists and clinicians include hepatobiliary & pancreatic surgeon, medical oncologist, interventional radiologist, radiation oncologist, gastroenterologist and anaesthesiologist.
He explains that while advances in medicine are having a positive impact on the treatment and survival of some patients, both liver and pancreatic cancers don’t always present symptoms early on, making them difficult to treat.
“Liver cancer and metastasis use to be considered a terminal condition a decade ago, however with recent advancement and refinement in surgical techniques we are now able to resect up to 65 per cent of the liver in some patients with a 5 year survival rate for colorectal liver metastasis up to 50 per cent.
“Pancreatic cancer unfortunately still has a dismal prognosis and only about 25 % of patients survive for five years or more even after surgery. Saying that, we are still able to offer surgery and resect pancreatic cancer if patients present early and have no distant metastasis/spread,” says Dr Majid.
Typical symptoms may include pain in the upper right side of the abdomen, fever, yellowing of the skin and eyes (jaundice), nausea, weakness, weight loss, loss of appetite. There is a history of bowel or other cancers in a patient who presents with secondary liver metastasis.
Diagnosis usually includes blood tests, ultrasounds, CT scans, MRI and biopsy. Following this, treatment options may include surgery, chemotherapy and radiotherapy. The need for chemotherapy or radiotherapy can often be dependent on pathology results.
Operations can be performed both laparoscopically (keyhole) or open dependent on the individual circumstances and the position of the disease within the body. This can also influence the duration of stay in hospital.
Causes of liver and pancreatic cancers are unknown however risk factors include: family history, personal history of bowel or other cancers, cirrhosis of the liver, cigarette smoking, chronic alcoholism and age over 65 years. Infection with hepatitis B, C also increases the risk of developing cirrhosis and primary liver cancer.
While disease of the pancreas and liver are serious, surgical advancements are likely to spur a more positive outcome over time.
“With the advancement of surgical and medical science the future is promising. With the introduction of targeted therapy, immunotherapy and personalised treatment it’s possible that cancer will become a chronic disease and patients would be able to live much longer with ongoing treatment as we have seen with diseases like HIV. However we are a long way away from that at the moment.”
