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The development of liver and pancreatic surgery, the specialized training of surgeons, the significant progress of technology and the improvement of anesthesia and patient management in the ICU, have contributed significantly to the fact that today, liver and pancreatic cancer surgery is a safe and applicable therapeutic approach.

The previous limitations to hepatectomy, such as intraoperative bleeding, bilateral localizations and multiple metastases, are no longer contraindications for resection. When hepatectomy is performed in specialized centers by experienced liver surgeons, the mortality rate is below 3%.

The safety of patients with liver tumors is ensured by careful preoperative preparation and the use of liver parenchymal augmentation techniques, such as portal vein embolization (PVE). Today, in hepatectomies, we use modern technology for parenchymal resection (CUSA, MISONIX), RFA and Microwave for tumor destruction. Also, the use of intraoperative ultrasound (IUS) for intraoperative localization of tumors and liver vessels is very important.

Diseases:

• Hepatocellular carcinoma
• Cholangiocarcinoma (intrahepatic and portal)
• Secondary sites (metastases)
• Primary liver sarcomas
• Other rare tumors
• Liver adenomas
• Cystic liver neoplasms

Pancreatic surgery

In addition to liver surgery, pancreatic surgery has also become particularly safe in recent years. Improvements in surgical techniques (portal vein and superior mesenteric vein resections and reconstructions) along with better training and specialization of surgeons have resulted in a reduction in perioperative mortality, intraoperative and postoperative bleeding, and anastomotic leaks.

Pancreatic cancer is a very aggressive cancer, which is usually diagnosed at an advanced stage. Patients who develop jaundice early are also more likely to be able to undergo surgery. The addition of more effective chemotherapy regimens has significantly improved the results of chemotherapy and can transform an inoperable or marginally resectable disease into a resectable one.

Diseases:

• Pancreatic cancer (head, ankylosis, body, tail)
• Cystic neoplasms of the pancreas (mucinous cystadenoma, IPMN)
• Cancer of the terminal bile duct
• Cancer of the Vater’s tubercle

Surgical techniques

Liver

• Open hepatectomy
• Laparoscopic hepatectomy
• Robotic hepatectomy
• Tumor destruction with RFA, Microwave, IRE

Pancreas

• Whipple or pancreaticoduodenectomy (open or laparoscopic)
• Peripheral pancreatectomy with or without spleen preservation (open or laparoscopic).
• Robotic resection

It is important to emphasize that in recent years a significant number of hepatectomies and pancreatectomies can be performed laparoscopically and robotically with additional benefits for the patient such as rapid recovery, absence of large incisions in the body and postoperative pain.

The treatment of Liver and Pancreas diseases in highly specialized centers and, within the framework of an Oncology Council, with the collaboration of liver-pancreatic surgeons, gastroenterologists, hepatologists, oncologists, radiologists, anesthesiologists and intensivists, is the guarantee for optimal results and long-term survival.