Clinical Seminar: Transforming our approach to the diagnosis and treatment of liver, biliary tract and pancreatic cancers
Abstract: Cancers of the liver, bile duct and pancreas are only cured by major surgery which is usually performed by an open procedure with significant morbidity and risk of mortality. Because of the complexity of the surgery laparoscopic and robotic surgery are only slowly being introduced into clinical practice. Image guidance systems may transform the need for open liver surgery and the development of a ‘Smart surgery’ image guidance system at UCL will be discussed. Image guidance may also have an important role in local ablation cancer therapies for the liver such as radiofrequency and microwave ablation and our experience in the steps and challenges for introducing and evaluating these new technologies through support from NIHR Health technology Assessment (HTA) will be described. Bile duct cancers present with jaundice but differentiating benign from a cancerous blockage may be impossible with current imaging. Optical methods of detecting and evaluating cancers in the bile duct at the time of endoscopy (ERCP) will be described along with the limitations of current techniques and how this could radically change surgical practise. Finally the major clinical problem of pancreas cancer will be discussed. Earlier diagnosis is essential to improve survival. Many cancers are thought to develop from benign cystic tumours and new methods to treat these pre-malignant lesions by endoscopic therapy will be described along with novel methods to facilitate localisation of the cystic tumours at time of endoscopy. Lastly for the > 50% of patients with advanced pancreas cancer at presentation which are beyond cure with surgery and have limited response to chemotherapy the development of exciting new approaches such as electrolytic therapy (IRE) and High Intensity Focussed Ultrasound (HIFU) will be discussed along with the opportunities for exciting research to optimise these and other techniques within a revolutionary hybrid image guided operating suite.
Speaker Bio: Brian Davidson is a consultant HPB and Liver Transplant Surgeon at the Royal Free Hospital and Professor of Surgery at UCL. Major research interests are in the treatment and pathogenesis of HPB cancers, organ preservation and ischaemia reperfusion injury and novel methods for minimally invasive HPB surgery. He is Editor of the UK Cochrane HPB Group, Director of UCL MSc in Evidence based Healthcare. He has completed 6 clinical trials in surgery, published over 400 peer reviewed articles and 22 book chapters. His H Index is 32. Recent grant income (last 5 years) is over £7M. Grant reviewer for NIHR, MRC, RCSEngl, CORE and PCRF.