HPB Surgery and Oncology


The biliary system refers to the organs that are responsible for producing and storing bile and impacting the digestive and metabolic processes. Bile is a fluid that aids the process of nutrient absorption, digesting fat, and waste removal. The gallbladder stores and concentrates bile, which is a fluid produced in the liver to help digest the fat contained in food. The hepatobiliary system is the liver, gallbladder, bile ducts, and pancreas. Surgical oncology is the broad medical field that uses surgery to treat cancer. Hepato-Pancreato-Biliary procedures are a subspecialty of oncology surgery specific to benign and malignant diseases of the liver, pancreas, and biliary tree. HPB surgery can be complex and requires specialized training and/or experience.


Dr. Joshua S Tierney’s surgery clinic is committed to helping cancer patients regain their health through the use of Hepatopancreatobiliary (HPB) and oncology Surgery.  Dr. Tierney is a reputable surgeon and pancreatic doctor with hundreds of successfully treated patients suffering from pancreatic and liver cancer. 

Pancreatic Cancer

The pancreas plays a vital role in balancing body blood sugar since it produces insulin, which is the enzyme that controls blood sugar levels. The pancreas can develop malignant tumors which then grow into full-blown pancreatic cancer with fatal results. Pancreatic cancer develops when a tumor grows in the pancreas.

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Pancreatic cancer, like any other cancer, starts from one or a few cells that divide uncontrollably and form a tumor. The tumor cells stay localized to the pancreas initially but can spread to lymph nodes or other organs (liver, abdominal cavity, lungs) as the cancer becomes more advanced. The exact reasons for DNA damage of pancreatic cells are not known, but several factors have been established to raise the risk of a person developing pancreatic cancer such as obesity, smoking, environmental exposures, and genetics.Pancreatic cancer can be very aggressive, progressing from stage I (localized disease) to stage IV (metastatic disease) in one year or less. It also is very difficult to diagnose early due to the lack of screening tests. The symptoms of pancreatic cancer are often vague and non-specific. For this reason, only 20% of patients with pancreatic cancer are diagnosed at an early stage. Symptoms for pancreatic cancer include jaundice, itching, weight loss, loss of appetite, diarrhea, new-onset diabetes, and vague abdominal pain.Pancreatic cancer can be treated if it is diagnosed early enough. Pancreatic surgery removes part or the whole of the diseased pancreas. Sometimes the tissue next to the pancreas will also be removed if cancer has spread. It is possible to survive without part of the pancreas. These procedures were done using open surgery in the past, but are done using minimally invasive robotic surgery.

HPB Surgical Oncology

Radiotherapy and chemotherapy are recommended cancer treatments. However, sometimes the way to deal with cancerous growth is to cut it out. Surgical oncology is the broad medical field that uses surgery to treat cancer. This is often to supplement or as an alternative to chemotherapy and radiotherapy.

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HPB Surgery & Oncology deals with liver and pancreatic cancers. Hepatopancreatobiliary (HPB) and oncology Surgery is the field where surgery is used to treat liver and pancreatic cancer. It is used alongside the other two treatments for a comprehensive treatment plan. While recommending treatment for a patient, the oncologist will look at age, physical fitness, stage of cancer, and the overall health of the patient. Any surgical procedure is preceded by comprehensive lab tests to read the patient’s biodata and other data that will inform the surgeon oncologist of the patient’s ability to withstand surgery.While surgical oncology procedures of the past used open surgery, more modern techniques have enabled the minimally invasive robotic surgery. The surgeon does the operation using a robotic arm with a camera and operating equipment. The arm goes through a minimal incision in the abdominal wall, the surgeon removes the diseased tissue and pulls it through the same incision. This newer surgery technique is easy for the surgeon and offers big advantages for the patient because there is less trauma. The patient heals faster and there is a lower risk of complications.

Whipple Procedure

The Whipple procedure is a type of HPB Surgery & Oncology treatment that is recommended for advanced pancreatic cancer that has spread to the small intestines, gallbladder, and bile ducts.

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This procedure is also known as a pancreaticoduodenectomy. It involves removing the head of the pancreas, the duodenum, the distal bile duct, and the gallbladder. This procedure is performed when the tumor is located in the head of the pancreas. In the late stages of pancreatic cancer, the gallbladder, bile duct, and the first part of the small intestines become affected by the disease as well. The Whipple procedure is done to prevent further spread of cancer by removing all of the diseased tissue. The surgeon removes the gallbladder, bile duct, and the head of the small intestines (duodenum) and then reconnects the remaining organs. The Whipple procedure is performed through both open and robotic approaches by Dr. Tierney.

Complex Biliary Surgery

Complex biliary surgery consists of an operation on the gallbladder, bile ducts, and other structures involved in producing and transporting bile between the liver and the gastrointestinal tract.

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The biliary tree consisting of the liver, gallbladder, and bile ducts is essential to the body's digestive and metabolic functions. These enzymes are involved in converting food into energy. These organs can be affected by several disorders including gallstones and liver cancer. This type of operation is typically performed as a conventional open abdominal procedure requiring general anesthesia. Open procedures have a likelihood of a short postoperative hospital stay.

Liver Resections

This is a surgical operation done to remove a portion of the liver. The liver is the body’s largest internal organ. It plays a vital role in digestion, producing bile to breakdown food.

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It also plays a crucial role in eliminating waste by breaking down toxins before they are flushed out. The liver is also a production center for several enzymes crucial to metabolism. Liver cancer is one of the common cancers and is often fatal if not diagnosed and treated early enough.