Department of Hepatobiliary Surgery @ Ospedale San Raffaele

Clinical and research activities are dedicated to improve both diagnosis and treatment for hepatobiliary diseases, with a particular commitment to oncological patients, affected by benign and malignant tumours.
The Hepatobiliary Surgery Unit is dedicated to the treatment of malignant and benign liver diseases of surgical interest, with a specific focus on primary tumours (such as hepatocellular carcinoma, intrahepatic and perihilar cholangiocarcinoma, rare tumors) and secondary tumors  (hepatic metastases coming from colorectal cancer, neuroendocrine tumour or non-colorectal non-neuroendocrine tumors) of the liver and the biliary tract.
More than ever before, liver surgery needs high-level, specific knowledge and expertise, both to exploit the most recent improvements in surgery techniques and technologies as well as to address properly the complexity of liver tumour pathology.
For this reason, at the San Raffaele Hospital there is a Hepatobiliary Surgery Unit exclusively dedicated – since more than a decade – to liver surgery, where over 3.700 hepatic resections have been performed, including all types of conventional hepatic resections, as well as specific programs for extensive resections and mini-resections, both with laparoscopic and robotic approach.
The program of Mini-Invasive Liver Surgery has been active for over 15 years, making the Hepatobiliary Surgery a national and international recognized leader in this field. The volume of the surgical activity is modulated on the number of patients, so that waiting times are limited and adequate to the severity of the diagnosis and the consequent need for a prompt, efficient, and effective treatment.

A multidisciplinary team (including hepatic surgeons, oncologists, hepatologists, interventional radiologists and radiotherapists) defines the diagnostic-therapeutic procedure for each patient during a specific weekly meeting (MMEB - Multidisciplinary Hepatobiliary Meeting). Thanks to this approach, the Hepatobiliary Surgery Unit of the San Raffaele Hospital has been able to constantly optimize the oncological results, mitigating surgery risks. A specific meeting for biliary tumors (DUCA – Disease Unit ColAngiocarcinoma) is held every two weeks, to specifically discuss about patients with intrahepatic and perihilar cholangiocarcinoma and gallbladder cancer. 

Between January 2004 and November 2021, 3763 liver resections were performed at the Hepatobiliary Surgery Unit of the San Raffaele Hospital. Details regarding open procedures are shown in Figure 1, below. In particular, 190 patients had an inadequate volume of the remnant liver at the moment of diagnosis and therefore required procedures to induce hypertrophy of the liver remnant (Portal vein embolization/ligation, hepatic deprivation, two stage hepatectomy, ALPPS procedures).
Details regarding minimally-invasive liver resections are provided. The number of laparoscopic resections has progressively increased from 2005 (when it constituted 5.8% of the whole series of liver resections) to 2020 (now it constitutes 65% of the whole activity).