The tumours in this group
The liver, pancreas and bile ducts work together and drain through a shared channel system, which is why tumours arising in them are handled as a single surgical field. The group includes hepatocellular carcinoma arising from liver cells themselves, secondary tumours that have spread to the liver from elsewhere — most often from the colon — pancreatic cancer, gallbladder cancer and cholangiocarcinoma of the bile ducts.
These cancers can remain silent for a long time: the liver has considerable functional reserve and most of the pancreas sits deep within the abdomen, so symptoms often appear only once a tumour obstructs the flow of bile or presses on neighbouring structures.
The warning signs that matter most are yellowing of the eyes and skin, dark urine with pale stools, persistent itching, pain in the upper abdomen radiating to the back, loss of appetite and unintended weight loss. New painless jaundice always warrants prompt assessment, at any age.
Diagnosis and preoperative assessment
Assessment usually starts with ultrasound, followed by contrast-enhanced CT and, where needed, MRI with MRCP. These studies show the position and size of the tumour and — the critical question in this region — its relationship to the major blood vessels. Blood tests assess liver function and bile flow, and certain tumour markers help with monitoring.
Where the bile duct is obstructed, drainage may need to be relieved with a stent before any operation. When liver resection is planned, the volume and function of the liver that will remain afterwards is calculated separately: the liver regenerates well, but enough healthy tissue must be left behind for it to do so safely.
The decision to operate rests on whether the tumour can be removed completely. Size alone rarely settles it; what matters more is its relationship to the major arteries and veins, and the patient's fitness for a major procedure. This judgement is made in a multidisciplinary board bringing together surgery, medical oncology, radiology, interventional radiology, gastroenterology and pathology.
The operations used
Surgery here means removing the tumour together with a margin of healthy tissue and then rebuilding the drainage system that carries bile and pancreatic secretions into the intestine. Several of these procedures are among the most extensive in abdominal surgery and should be undertaken by a team experienced in this field.
Which operation applies depends on where the tumour lies. In the liver, the affected segment or lobe is resected. For tumours in the head of the pancreas, the pancreatic head, the duodenum and part of the bile duct are removed together and the digestive tract is reconstructed with three separate anastomoses — the Whipple procedure. Tumours in the body or tail of the pancreas are treated by distal pancreatectomy. Gallbladder and bile duct tumours generally require removal of the adjacent liver tissue and the involved duct segment along with the regional lymph nodes.
- Liver resection: removal of the involved segment or lobe
- Whipple procedure (pancreaticoduodenectomy) for tumours of the pancreatic head
- Distal pancreatectomy for tumours of the body and tail
- Bile duct resection with biliary-enteric reconstruction
- Regional lymph node clearance and pathological examination
Where minimally invasive surgery fits
Laparoscopic techniques are used in this group chiefly for early-stage disease and favourably located tumours. Working through small incisions spares the abdominal wall, which generally means less pain after surgery, earlier mobilisation and a quicker return to normal activity.
Even so, hepatobiliary and pancreatic surgery is a field where the closed approach cannot be applied to everyone. Proximity to the major vessels, the tumour's position within the liver, adhesions from previous operations and the complexity of the reconstruction all bear on the choice. The priority in these operations is always complete and safe removal of the tumour; the size of the incision comes second.
Our surgeons assess this individually, weighing the imaging findings against the patient's general condition. Beginning an operation laparoscopically and completing it open is a deliberate judgement made in the interest of safety, not a setback.
Recovery and multidisciplinary follow-up
Recovery varies considerably with the extent of the procedure. After liver resection, liver function is monitored closely in the early days. After pancreatic surgery, feeding is advanced gradually; some patients need enzyme supplements with meals, and depending on how much of the gland was removed, blood sugar may need monitoring. After bile duct surgery, attention focuses on whether bile is draining as it should.
In this group of cancers, surgery is almost never the whole of treatment. Chemotherapy or radiotherapy may be planned according to the pathology result, and some patients receive treatment before the operation rather than after it. Follow-up is therefore shared between the surgical team and medical oncology, combining clinical review, blood tests and imaging at defined intervals over a long period.
This page is general information and is not a substitute for consultation. Whether an operation is appropriate, which operation, and in what order treatments should be given are determined for each patient from the imaging and the clinical picture together. Patients are seen at İzmir Cerrahi Merkezi in Konak, İzmir; bringing existing CT, MRI and pathology reports makes the first consultation considerably more useful.
Frequently asked questions
What does painless jaundice mean?
It means bile is not draining freely, and the cause is not always cancer — gallstones and benign strictures can produce the same picture. It does, however, need prompt investigation until the cause is established, usually beginning with blood tests and imaging.
Can these operations be done laparoscopically?
In selected patients with favourably located tumours, yes, and it is used most often in early-stage disease. Proximity to the major vessels, the position of the tumour within the liver and the complexity of the reconstruction can all make an open approach the safer choice. The decision is made individually after imaging.
What happens if part of my liver is removed?
The liver has a strong capacity to regenerate and continues to function provided enough healthy tissue remains. That is why the volume and function of the future remnant are calculated before surgery. How much can safely be removed differs from patient to patient.
What is the Whipple procedure?
It is the operation used for tumours in the head of the pancreas, removing the pancreatic head, the duodenum and part of the bile duct together. The pancreas, bile duct and stomach are then each joined to the small intestine to restore digestive continuity. It is a major procedure requiring careful preparation and an experienced team.
Is every patient a candidate for surgery?
No. Operability depends on the tumour's relationship to the major vessels, the extent of disease and the patient's general condition. Some patients are given chemotherapy first and reassessed for surgery if the tumour responds; for others, treatment is delivered without an operation. The multidisciplinary board makes this call.
Will my diet change after the operation?
After pancreatic surgery, food is reintroduced gradually and some patients need enzyme supplements with meals; blood sugar may also need monitoring depending on how much of the pancreas was removed. Most patients return to a normal diet after liver resection. The course varies from patient to patient and is managed through regular review.