Complex resections, honestly assessed.
HPB surgery asks the hardest question in oncology: should this be operated on at all? Here that question is answered with liver-volume science and tumour-board discipline — and sometimes the honest answer is a plan without surgery.
What is HPB cancer surgery?
It covers the liver — primary tumours and metastases alike — the gallbladder, the bile ducts, and the pancreas. These are the operations other surgeons refer onward: large resections where planning matters as much as technique.
The liver has a quiet gift: it regenerates. Modern strategy uses this — measuring remnant volume beforehand, and when it is too small, growing it deliberately with two-stage approaches such as ALPPS or portal vein embolisation. What was once inoperable becomes operable, safely.
The standard here. Every major resection passes through volumetry and a multidisciplinary board first. An operation is offered because the numbers support it — never because declining one feels awkward.
Signs that deserve investigation
Jaundice is never normal. Combined with any of the following, it warrants same-week attention — most causes will be stones or infection, but the ones that are not need time on their side.
- ①Yellowing of the eyes or skin — jaundice, however mild.
- ②Generalised itching that persists without rash.
- ③Pale, clay-coloured stools.
- ④Dark urine without dehydration to explain it.
- ⑤Pain in the upper-right abdomen, constant or recurring.
- ⑥Sudden diabetes appearing with weight loss — a pancreatic signal.
- ⑦Fever occurring with jaundice — urgent, the same day.
- ⑧Loss of appetite with steady weight loss.
Cancers treated here
◆Primary Liver Cancer
Hepatocellular and other primary tumours, resected along anatomical segments.
◆Liver Metastases
Colorectal spread to the liver — often curable with properly planned resection.
◆Gallbladder Cancer
Radical cholecystectomy, including incidentally found disease needing completion surgery.
◆Bile Duct Cancer
Cholangiocarcinoma managed with bile duct resection and hepaticojejunostomy.
◆Pancreatic Cancer
Whipple and distal resections, selected on vessels and volumes rather than optimism.
◆Small-Remnant Livers
ALPPS and portal vein embolisation strategies that make marginal cases safe.
Operations performed here
- ◆Segment-oriented liver resectionsTissue removed by anatomy, preserving every segment that can stay.
- ◆Right & left hepatectomyMajor resections planned on measured remnant volume.
- ◆Whipple procedurePancreaticoduodenectomy — the definitive operation for cancers of the pancreatic head.
- ◆Distal pancreatectomy & splenectomyFor body and tail tumours, with spleen preservation considered where safe.
- ◆Radical cholecystectomyThe complete operation gallbladder cancer requires — not a simple removal repeated late.
- ◆Bile duct resection & hepaticojejunostomyReconstruction of drainage with lasting patency in mind.
From first visit to full recovery
Imaging & volumetry
Liver volumes are measured before anything is promised.
Biopsy & markers
Tissue diagnosis obtained where it changes the plan.
Tumour board review
Medical and radiation oncology shape the sequence with us.
The operability decision
Surgery offered only when the numbers support it — including an honest no.
Surgery
Precise resection with reconstruction, in centres equipped for it.
Regeneration & surveillance
The remnant liver monitored as it regrows; scans on schedule thereafter.
Questions families ask first
It is major surgery, and pretending otherwise serves no one. But risk falls sharply when resection follows proper volumetry, staging and case selection. Most patients who pass through this pathway recover fully.
Yes — uniquely among organs. The remaining liver regenerates over weeks, which is why segment-sparing technique and remnant-volume measurement matter so much. Two-stage strategies use this biology deliberately.
Because it is technically demanding and outcomes vary enormously between centres and surgeons. The honest response is not avoidance but selection: the right patient, the right centre, the right indication.
No — stones and strictures are commoner causes. But jaundice always deserves prompt investigation, because the causes that are cancer reward early attention.
A real plan, not a shrug: chemotherapy, targeted options, biliary drainage for comfort, and surveillance to revisit operability if the disease responds. You will never be left without a direction.