UCSF Liver Transplant Service and the NEW Hepatobiliary Service HBS Nancy L. Ascher, MD, PhD Professor and Chair UCSF Department of Surgery The Nathan Bass UCSF Liver Transplant Conference 2011

New HB(P)S Hepatobiliary Pancreas Service New service bringing together individuals with interest/expertise in liver surgery, disease management, and pathology.

HBS Focuses on benign and malignant (both primary and metastatic) diseases of the liver and bile ducts. Caveat: Patients with underlying chronic liver disease are still cared for on the liver (Tx) service where expertise in management of hepatic decompensation is optimal.

Reason for New Service Current Model: Dispersed practitioners in multiple hospitals and services “individually” treating patients with complex HB problems. This traditional model is prone to fostering non-uniform and in some case, suboptimal treatment strategies.   Proposed Model: Establish a unified group (TEAM) of surgeons with the common goal of providing optimal care specifically for patients with benign and malignant diseases of the Liver, Gallbladder and bile ducts. An essential element of this HB surgical service will be to integrate as part of a comprehensive multidisciplinary disease treatment team consisting of Surgery, Gastroenterology, Diagnostic and Intervention Radiology, Medical and Radiation Oncology, Pathology and Anesthesiology. Ideally, all patients will be reviewed by our Multidisciplinary team and be offered the best combination treatment strategies.

Spectrum of Diseases Seen by HBS Bile duct injuries Congenital bile duct anomalies Benign liver tumors Primary liver cancers Bile duct cancers Metastatic liver cancer

HBS Participants Hepatologists Transplant surgeons Oncologic/HB Surgeons GI oncologists Liver anesthesiologists Interventional radiologists

HBS Organization Surgeons led by Dr. Carlos Corvera Dedicated service with 2R5s, 1R1, NP support Dedicated block time 13L

Hepatobiliary Surgical Service Providers Nancy L. Ascher, MD, PhD Jonathan Carter, MD Carlos U. Corvera, MD Sandy Feng, MD Chris E. Freise, MD Hobart Harris, MD, MPH Ryutaro Hirose, MD Sang-Mo Kang, MD Eric Nakakura, MD, PhD Andy Posselt, MD John P. Roberts, MD Stanley Rogers, MD

OR Block Time Monday Tuesday Wednesday Thursday Friday Monday Time   OR 27 OR 28 0730-1200 HPB Team #1 HPB Team #3 1200-1500 1500-1900 Tuesday Time OR 14 HPB Team#2 Wednesday time OR 17 0830-1200 * Varma HBP Team#3 Way Available Thursday Time OR 4 OR 25 OR 2 RED SURGERY Friday Time OR 16 Kirkwood Not Ours Tuesday Wednesday Thursday Friday

HBS – Patient portals Clinics at Parnassus and Mt. Zion cancer center Tuesday tumor board Parnassus (Radiologists, IR, hepatologists, surgeons and oncologists) Wednesday tumor board Mt. Zion (Radiologists, IR, surgeons and oncologists) Entry into service via hepatology, medical oncology, surgery or IR Anesthesiologists play central role in organization and scheduling

Impact of HBS Implementation of Multidisciplinary Conference: The HBS outpatient clinic was developed around the concept that surgeons and medical oncologists would be physically in the same clinic space to facilitate interactions and cross-consultation. Research Goals: Increasing collaborative efforts among disciplines for patient recruitment (clinical trials and tissue collection, etc.). Data collection: Database development for the new service and integration with exciting databases. Nurse Navigator to help coordinate clinical care and direct clinical research efforts between the various services.

HBS case 28 year old female with abdominal discomfort Large liver tumor identified; metastatic neuroendocrine PMH: AML Rx’d with whole body irradiation and BM TX at 5 years Metastatic papillary thyroid CA S/P thyroidectomy and neck dissection

POD #4