UCSF Liver Transplant Service and the NEW Hepatobiliary Service HBS
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Transcript of UCSF Liver Transplant Service and the NEW Hepatobiliary Service HBS
UCSF Liver Transplant Service and the NEW Hepatobiliary Service HBS
Nancy L. Ascher, MD, PhDProfessor 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 Time OR 27 OR 28
0730-1200 HPB Team #1 HPB Team #3
1200-1500 HPB Team #1 HPB Team #3
1500-1900 HPB Team #1 HPB Team #3
Tuesday Time OR 14
0730-1200 HPB Team#2
1200-1500 HPB Team#2
1500-1900 HPB Team#2
Wednesday time OR 17 OR 27 OR 28
0830-1200 * Varma HBP Team#3 Way
1200-1500 * Varma HBP Team#3 Way
1500-1900 * Varma HBP Team#3 Available
Thursday Time OR 4 OR 25 OR 2
0730-1200 RED SURGERY RED SURGERY HPB Team #1
1200-1500 RED SURGERY RED SURGERY HPB Team #1
1500-1900 RED SURGERY RED SURGERY HPB Team #1
Friday Time OR 16 OR 25 OR 27 OR 28
0730-1200 RED SURGERY RED SURGERY RED SURGERY Kirkwood
1200-1500 RED SURGERY Not Ours RED SURGERY Kirkwood
1500-1900 RED SURGERY Not Ours RED SURGERY Kirkwood
Monday
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