Our Approach & Expertise

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Our team includes a group of specialized interventional radiologists who are expert in using nonsurgical, minimally invasive treatment procedures with the help of image guidance from computed tomography (CT) scans and ultrasound.

Leading Edge of Surgical Technique

For most hepatobiliary cancers, surgery is often the most effective therapy, and therefore proper surgical evaluation is an important part of devising a treatment plan. Our surgeons have developed a full range of techniques for effective and safe surgery, which often allow us to operate on patients whose tumors are considered inoperable at other institutions. If additional therapy is necessary following surgery, experienced gastroenterologists, interventional radiologists, radiation oncologists, and medical oncologists are on staff.

Our surgeons, who perform roughly 300 liver operations each year, pioneered a surgical approach that significantly reduces blood loss and the need for potentially complication-causing blood transfusions. Our doctors are also developing "liver-sparing" surgical techniques that leave more of the healthy liver intact. Partly as a result of these techniques, most patients at Memorial Sloan-Kettering require a hospital stay of less than ten days following liver surgery, and the majority of these patients do not need additional blood transfusions.

Memorial Sloan-Kettering has also pioneered laparoscopic methods for both the diagnosis and treatment of hepatobiliary cancers. Laparoscopy is the insertion of a thin, lighted tube with a camera at its tip through a small incision in the abdominal wall. The instrument used is called a laparoscope. This technique can be used to inspect the inside of the abdomen and remove tissue samples for a biopsy. Surgical instruments can be used during laparoscopy. For example, in selected cases surgery can also be performed with the aid of a laparoscope for removal of part of the liver -- a procedure known as partial hepatectomy.

Our investigators have shown that hepatobiliary surgery can be performed on elderly patients with good outcomes that are comparable to those of younger patients, and that age should not be the sole determinant when deciding whether a patient over the age of 70 is a candidate for surgery.

Approaches to Image-Guided Therapies

At Memorial Sloan-Kettering, our team of interventional radiologists is a leader in percutaneous, minimally invasive therapy. These are treatments that are performed "through the skin" without conventional surgery or incisions into the body, and are administered with the help of image guidance such as computed tomography (CT) or ultrasound. A range of these procedures are performed at Memorial Sloan-Kettering, including embolization, thermal ablation, and chemical ablation. Our goal is to treat patients using methods that minimize the time patients spend in the hospital as well as their overall recovery time.

Our doctors and researchers are actively involved in the development and study of many of these new treatment approaches. In some cases, diagnosis is performed invasively, by removing a small amount of tissue for a biopsy, or by inspecting parts of the interior of the abdomen using a laparoscope.

Advanced Imaging Technology

Diagnosing hepatobiliary cancer can be difficult because this part of the body is complex and includes several organs and major blood vessels. Planning surgical treatment or selecting other therapies for hepatobiliary tumors depends on high-quality diagnostic imaging of tumors. Memorial Sloan-Kettering has a team of radiologists who specialize in hepatobiliary imaging.

CT, magnetic resonance imaging (MRI), ultrasound, and nuclear medicine scans are the primary noninvasive diagnostic methods used at Memorial Sloan-Kettering. Over time, these imaging techniques have become more sophisticated and are capable of revealing more details, such as the exact size, density, and nature of a newly diagnosed tumor, as well as a tumor's response to treatment.

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Investigational Approaches

As the goal is to improve outcomes for this disease, our team of physician-scientists at Memorial Sloan-Kettering incorporates novel targeted therapies in the treatment of hepatobiliary tumors. These drugs are specially engineered antibodies, or molecules with specific targets that are present in the cancer and not in the normal tissue. For example, these drugs may block a specific mechanism that triggers the replication of cancer cells, or they may help stop the blood supply to the tumors. There are a number of clinical trials underway to treat different kinds of hepatobiliary tumors. For up-to-date information about current clinical trials at Memorial Sloan-Kettering, please visit our clinical trial database.

One of the challenges in the surgical treatment of liver cancer is that even after complete removal of all visible tumors, cancer recurs in about two-thirds of all patients. This is most likely the result of microscopic cancer cells in the liver that could not be detected by the oncologist or surgeon and that continued to grow after surgery. Our doctors pioneered the use of intra-hepatic infusion chemotherapy in the treatment of colon cancer that has spread to the liver, and the use of this chemotherapy regimen in combination with liver surgery. Intra-hepatic infusion chemotherapy is administered directly to the liver through a pump in the abdomen. A new study has been initiated to assess the safety and effectiveness of this same therapy in patients with primary liver cancers that cannot be completely removed surgically.

To eliminate residual cancer cells that may remain after liver surgery, researchers at Memorial Sloan-Kettering are also investigating ways to use patients' own immune systems against such cells. In addition, there is promising research involving oncolytic viruses (viruses that selectively infect and kill tumor cells), and further investigations are underway to learn more.