Pancreatic cancer is a tough and severe cancer prognosis. Of all the major cancers, pancreatic has one of the worst survival durations. The survival length of untreated advanced-stage pancreatic cancer is around 3.5 months.  Early diagnosis and treatment are critical for effective treatment. One of the most complex surgical procedures performed, hepato-pancreato-biliary surgery, is the best chance to cure the condition.

Learn more about pancreatic cancer and treatment from The Surgical Clinic in Tennessee below.

HPB Surgery for Pancreatic Cancer

More commonly referred to as HPB, hepato-pancreato-biliary surgery encompasses various procedures that treat conditions in the liver, bile system, and pancreas.

Cancer is the cause of many of the illnesses addressed by hepatobiliary surgery. Tumors can occur in the liver, pancreas, and bile ducts, which can be benign or malignant. When tumors in other regions of the body, such as the colon, metastasis and spread, these organs might become malignant. As a result, the majority of people who need hepatobiliary surgery are individuals who have been diagnosed with cancer of the liver, pancreas, or bile ducts.

Hepatobiliary surgery may be required in some persons who have significant gallstones that are preventing them from passing naturally. Hepatobiliary procedures can also be utilized to treat liver problems such as fatty liver disease or long-term heavy alcohol consumption. Some disorders, such as hepatitis, can force a patient to undergo surgery.

Complex Issues – Role of the Pancreas

Together, the liver, gallbladder, pancreas, and duodenum form an important subsystem within the digestive system. Enzymes, bile, and bile salts produced and stored in the gallbladder inject into this tract during digestion. The pancreas also produces enzymes and adds them to the intestinal tract for digestion.

Collectively, these naturally produced enzymes, biles, and salts break down food into manageable nutrients for the body to store or use.

These organs are essential for the effective digestion of food. As a result, diet plays an integral part in maintaining this complex and interconnected system within the body.

There are also other vital structures and major blood vessels through the abdomen on top of these essential organs. Altogether, these systems make operating in the abdomen complex and challenging.

Complex Treatment – Pancreatic Cancer Survival

It takes the teamwork of physicians and surgeons to treat the conditions of pancreatic cancer. If you need full HPB care, you won’t be working with just one surgeon or one provider. Needing a team is especially true for cancer patients. We take a team approach to treatment to determine the best path for treatment accurately.

For example, an HPB treatment team would include your primary care provider, a general surgeon, and a surgical oncologist. You may also meet with a nutritionist, a radiology specialist, or a pathologist.

When you work with a team of hepato-pancreato-biliary surgery specialists, you will play an active role in shaping your treatment. It will be up to you whether you undergo surgery or only want a recommendation for treatment.

Types of HPB Conditions

HPB surgery covers a wide range of conditions that affect the liver, pancreas, and bile system. Surgeons who specialize in this field, therefore, treat a wide array of conditions that can be either malignant or benign.

Malignant Hepato-pancreato-biliary Conditions

Hepatobiliary Cancer

Generally speaking, hepatobiliary cancer includes any cancer that originates in the liver, gallbladder, or bile ducts. The difficulty of diagnosing liver cancers is, in part, due to the vagueness of symptoms and confusion with symptoms of other conditions. Some signs of liver cancer include abdominal pain, weight loss, weakness, and jaundice.

Pancreas Cancers

The most common type of pancreatic cancer is pancreatic ductal adenocarcinoma (PDAC). The cancer cells begin developing in the lining of the pancreatic duct before it spreads to other areas of the body. Typically, this cancer spreads before it is detected. PDAC is aggressive and often lethal. Therefore, it’s essential to ask your doctor about your risk factors for pancreatic cancer. Symptoms often won’t occur until the cancer is in advanced stages. Abdominal pain, loss of appetite, light stool, dark urine, blood clots, and fatigue are all possible signs of pancreas cancer.

Islet Cell Tumors

Pancreas cells cluster together in groups. When a cancer tumor occurs in these small cell groups, it is called an islet cell tumor. These tumors can be either benign or malignant. Also called pancreatic neuroendocrine tumors, islet cell tumors are rare and grow slowly. As a result, symptoms can be hard to detect until later stages. But, like other hepatobiliary cancers, symptoms can include abdominal pain, jaundice, and back pain.

Benign Hepato-pancreato-biliary Conditions

The following conditions are non-cancerous diseases that occur anywhere within the liver, pancreas, gallbladder, or bile ducts. Some of these conditions require treatment by only one general surgeon. Others may need the attention of a team of specialists.

Chronic Pancreatitis

This condition occurs when the pancreas becomes and stays inflamed. Over time, constant inflammation damages the pancreas’ structure and ability to function. As a result, patients with chronic pancreatitis have a higher risk of diabetes due to inhibited insulin production.

Symptoms of chronic pancreatitis include abdominal pain, back pain, and diabetes. If your health history includes smoking or alcohol abuse, you have a higher risk of developing chronic pancreatitis. Additionally, people who have a family history of chronic pancreatitis have a higher risk, as well.


The gallbladder is a small organ located just below your liver. Its primary function is to store and release bile into the digestive tract to aid in digestion. However, over time, high levels of cholesterol in bile can form gallstones. When the gallbladder gets blocked by a build-up of gall stones, it causes bouts of pain as the gallbladder tries to pass the stones. Minimally invasive robotic gallbladder surgery at The Surgical Clinic helps patients recover from surgery faster than traditional surgical methods.

These conditions, especially liver and pancreatic cancer, can be hard to identify in their early stages. Diagnosing and treating these conditions is difficult for this reason.

Other Notable Conditions Related to Pancreatic Cancer


When the liver is damaged, it repairs itself. This damage can happen from consuming large amounts of alcohol or from diseases like hepatitis. Over time, the rehealing of these injuries can create scarring, known as fibrosis. Cirrhosis raises the risk of developing pancreatic cancer.

What Surgeries are Performed in HPB Surgery?

To remove pancreatic cancers, these are some of the most common surgical procedures performed.

Whipple Procedure

Whipple procedure is a complex surgical treatment for pancreatic cancer that is often lifesaving. The pancreas head is surgically removed along with the gallbladder, bile duct, and a portion of the small intestine. With the tumors removed, the organs are surgically reattached to allow normal digestion.

Distal Pancreatectomy

During a distal pancreatectomy surgery, the body and tail of the pancreas are surgically removed.  If the cancer has spread, the spleen may also be removed. As the spleen is beneath the rib cage, enlarged tumors are often not felt. The spleen filters blood and helps with immunity.

Total Pancreatectomy

A total pancreatectomy is a complicated surgical procedure to treat pancreas cancer. As the name suggests, the entire pancreas is removed. Often times, the spleen, gallbladder, bile duct, and partial intestine are also removed.

Without the pancreas, the body can’t create insulin. Combining this procedure with an islet cell transplant is necessary to prevent diabetes.

If you suspect you are developing pancreatic cancer, scheduling a screening is imperative. The board certified surgeons at The Surgical Clinic can administer the correct tests to diagnose pancreatic cancer. Treatment will depend on the stage of the disease and the tissues affected. This same surgical team will work together to treat or control the cancerous cells. Give The Surgical Clinic a call at the location nearest you.

Hepatopancreatobiliary surgeon

hepato pancreato biliary dr mariana chavez best general surgeon in nashville for hepato pancreato biliary hpb surgery with the surgical clinic

Hepato-pancreato-biliary (HPB surgery) is a very complex procedure and requires a highly skilled general surgeon or surgical oncologist who specializes in pancreatic cancer. At The Surgical Clinic, we have a team of experienced surgical oncologists who treat every patient with cancer individually. We’re proud to have Dr. Mariana Chavez, a hepato-pancreato-biliary surgeon who primarily treats cancers of the liver, pancreas and biliary surgery in Nashville on our surgical oncology team.

Research links:

Liver, Pancreas and Biliary Surgery. (n.d.). Atrium Health.

Hepato-Pancreato-Biliary (HPB) Surgery | Department of Surgery | University of Pittsburgh. (n.d.). University of Pittsburgh.

About types of Hepatico-pancreatico-biliary (HPB) conditions. (n.d.). University Hospitals Plymouth NHS Trust.
Plymouth Hospitals – Liver and HPB Conditions

Merck Manuals. (2019, October). Gallbladder and Biliary Tract. Merck Manuals Consumer Version.

Nashville General Surgeons at The Surgical Clinic

Suhail Allos, MD
General Surgeon

John A. Boskind, MD, FACS
General Surgeon

Patrick T. Davis, MD, FACS
General Surgeon & Bariatrics

Brent A. Fruin, MD
General Surgeon

Andrew W. Garrett, MD
General Surgeon

Trudie A. Goers, MD, FACS
General Surgeon

Bassam Helou, MD
General Surgery

Mark S. Hinson, MD, FACS
General Surgeon

George B. Lynch, MD, FACS
General Surgeon & Bariatrics

Clinton A. Marlar, MD
General Surgeon

James G. McDowell, MD, FACS
General Surgeon & Bariatrics

Willie V. Melvin III, MD, FACS
General & Robotic Surgery

Chad M. Moss, MD, FACS
General Surgeon

Gregory E. Neal, MD, FACS
General Surgeon

Drew H. Reynolds, MD
General Surgeon

James W. Richardson Jr., MD, FACS
General & Vascular Surgery

Joshua T. Taylor, MD, FACS
General & Robotic Surgery

Craig Ternovits, MD
General Surgeon

K. Tyson Thomas, MD, FACS
General Surgeon

J. Tyler Watson, MD
Minimally Invasive & Robotic General Surgery

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