The Division of Hepatobiliary and Pancreatic Oncology is primarily responsible for the treatment and management of cancers of the liver, biliary system and pancreas. The Division recognizes the importance of a multidisciplinary treatment strategy for the treatment of these cancers, and thus the treatment strategy for each patient at our Division is carefully discussed by surgeons, radiologists and medical oncologists in clinical case conferences. In clinical practice, standard treatment is applied to patients with these cancers, and clinical trials are undertaken to develop new and more effective treatments.
The Division consists of three staff oncologists, one part-time staff oncologist and one or two residents. The staff and residents are responsible for all of ultrasonographic (US) abdominal examinations at our hospital. In addition, they are also responsible for US-guided biopsy of the liver, pancreas and other abdominal masses, as well as percutaneous transhepatic biliary drainage (PTBD), percutaneous biliary stenting and percutaneous abscess drainage in patients with tumors of the liver, pancreas, or other abdominal organs, obstructive jaundice, and abdominal abscess. These procedures are conducted to determine the pathological diagnosis, alleviate jaundice, facilitate the removal of the PTBD tube, improve the quality of life of patients, and facilitate fever resolution. Furthermore, endoscopic biliary stenting has also been performed in recent years for patients with obstructive jaundice.
Most patients with unresectable hepatobiliary and pancreatic tumors are hospitalized in our wards, mainly 7A, for confirmation of the diagnosis and treatment of the tumors. The treatment strategy for each patient is discussed in case conferences, which are held weekly with the active participation of surgeons, radiologists, pharmacologists, and medical oncologists. Clinical rounds for patients admitted to our division are performed by all staff and residents every morning and evening.
For patients with advanced pancreatic and biliary cancer, gemcitabine monotherapy is recognized as the first-line therapy worldwide. Furthermore, S-1 has also been approved for this type of malignancy. In principle, gemcitabine monotherapy is administered as the first-line chemotherapy, and S-1 monotherapy is applied as the second-line chemotherapy.
In hepatocellular carcinoma (HCC), percutaneous ablation therapy is indicated as the standard treatment in patients with ≤3 tumors, each ≤ 3 cm in diameter. Transcatheter arterial chemoembolization (TACE) is routinely used for treating advanced or recurrent HCC when hepatectomy or ablation therapy is not indicated. Hepatic arterial infusion chemotherapy has been used for treating very advanced HCCs in patients not suitable for TACE. Patients with distant metastasis are recognized as suitable candidates for systemic chemotherapy. However, no standard regimen for systemic chemotherapy has so far been established in Japan, while sorafenib has been demonstrated to show promise as a standard treatment for advanced HCC patients in western countries.
| Number of patients treated (2004-2008) | |||||
| 2004 | 2005 | 2006 | 2007 | 2008 | |
| New referrals | 285 | 223 | 291 | 304 | 337 |
| HCC | 116 | 77 | 97 | 120 | 139 |
| Biliary tract | 49 | 42 | 60 | 66 | 58 |
| Pancreas | 103 | 104 | 134 | 118 | 140 |
| Re-admission | 311 | 323 | 478 | 666 | 665 |
| HCC | 222 | 212 | 289 | 346 | 431 |
| Biliary tract | 32 | 30 | 47 | 139 | 83 |
| Pancreas | 56 | 81 | 142 | 181 | 151 |
| Total | 596 | 546 | 769 | 989 | 1002 |
| HCC | 338 | 289 | 386 | 485 | 570 |
| Biliary tract | 81 | 72 | 107 | 205 | 141 |
| Pancreas | 159 | 185 | 276 | 299 | 291 |
Table of Contents