Parsia Vagefi, M.D. Answers Questions On: Complex Hepatobiliary Surgery

Hepatobiliary surgery helps manage benign or malignant tumors and conditions of the liver or bile duct and usually involves cutting out parts of the liver and/or bile duct. We leverage the techniques we've learned from liver transplants, which includes being able to reroute blood vessels to the liver in order to be able to perform some of the more complex resections that require vascular reconstruction.

Many operations involve the liver and bile duct. For instance, surgical oncologists might perform Whipple procedures, and they might need the portal vein (the main vein that feeds the liver) to be resected and reconstructed in order to get the tumor out, and we are here to help them do this. We also see patients who have tumors in the vena cava, the main vein in the abdomen taking blood back to the heart. We can cut out that vein, and part of the liver if needed, to help get the vena cava tumor out. 

The most extreme cases can involve taking out someone's entire liver, cutting out the tumor, and then reimplanting the normal piece of liver back into the patient – in essence an auto-transplant. That's a very complex operation, and that’s the extreme. But it's an area where we try to bring our vascular-based skillset to help our surgical oncology colleagues get these patients tumor free.

With each patient, we ask, “What is the best way forward?” It depends on the tumor: Do they need upfront chemotherapy? Do they need something unique done? We evaluate every patient individually. We often see patients who are seeking second opinions – those who come to us having heard, for example, that their tumor isn’t resectable – and it’s very rewarding to be able to use a team-based approach to be able to offer that patient a chance at resection, and a chance for a cure.

Complex hepatobiliary surgery is an area in which we've always worked to push the envelope a little bit. It’s very technical, so the future is going to be a collaboration with our colleagues in medical oncology and interventional radiology to help us decide which patients can be resected or not. Using a complement of therapies is going to be key.

Some patients might present with tumors that are still unresectable but that can be shrunk by the oncologist or the radiologist. Afterward, once they are smaller, we can resect them. I think this field will evolve as we develop better chemotherapies and better tumor-directed therapies. Hopefully, it will evolve to a point where we're able to offer a truly curative surgery for more patients.