Formal designation increases access to hepatic, pancreatic and biliary tract surgery

St. Joseph’s Health Centre Toronto (St. Joe’s) has been formally recognized by Cancer Care Ontario as a designated site in the province for Hepatic, Pancreatic and Biliary Tract (HPB) surgery. This designation gives them the ability to increase access to HPB surgery for cancer patients, which requires treatment by surgeons with highly technical and specialized surgical training.

“We have always been able to provide this type of surgery, providing excellent care and results for our patients – and now we are one of several sites in the province recognized by Cancer Care Ontario (CCO) to deliver this surgery as a centre of excellence,” explains Dr. Richard Hart, Surgical Oncology, Hepatobiliary and Pancreatic Surgeon, who specializes in HPB surgery and has been on staff at St. Joe’s since 2001.

He is a clinical leader in this area and was recruited for his expertise in HPB surgery, which is a sub-specialty area of general surgery. Dr. Hart performed over 50 HPB cancer surgeries last year as well as a significant amount of surgeries for benign disease.

“According to Cancer Care Ontario guidelines, patients with a HPB cancer diagnosis should be operated on within 28 days from the time a decision is made to operate, targets we are committed to strictly adhering to,” says Dr. Hart.

As a hospital with high HPB surgical volumes combined with a formal designation from Cancer Care Ontario, “St. Joseph’s can continue to respond to the needs of patients in the communities we serve and improve the quality of life for people suffering from the devastating affects of liver and pancreatic cancers,” he adds.

Dr. Hart explains that his work as a single surgeon met the criteria of surgical volumes and outcomes as outlined by CCO guidelines. St. Joseph’s also brought on an additional surgeon, Dr. Shiva Jayaraman, who has also undertaken extensive fellowship training in the management of hepatic and pancreatic disease, to allow us to further increase the volume of patients treated at St. Joe’s.

Additional requirements under the CCO guidelines St. Joe’s met to become a designated centre include having 24-hour a day access to fully equipped operating rooms; onsite access to a full range of diagnostic imaging procedures and equipment in all modalities as well as interventional radiology; onsite access to therapeutic endoscopy; access to an Intensive Care Unit (ICU) with expertise in treating surgical patients undergoing major HPB surgeries; a fully developed nutrition service (including total perenteral nutrition); nursing personnel with experience in the management of complex abdominal surgical problems; and supportive care services such as pain management expertise, psychosocial care and palliative care.

Along with improving patient care and surgical outcomes for patients, the HPB designation is also strengthening St. Joe’s commitment to educating the next generation of health professionals and our contributions to important research studies.

“We are affiliated with the University of Toronto’s Division of General Surgery. We have a full compliment of residents and fellows coming here to train in all facets of surgery,” says Dr. Hart. As a centre of excellence, we will be able to expose our residents to an even higher volume of HPB oncology (to increase their learning opportunities in this specialty area). We are also working to put together a lecture series for all HPB fellows in the city in partnership with Sunnybrook and University Health Network (the two other designated HPB surgery sites in Toronto),” he adds.

St. Joe’s also participated in a province wide prospective randomized trial looking at the use of Positron Emission Tomography (PET) scanning prior to hepatic re-section of colorectal metastases. PET scans have the ability to show surgeons if there is more extensive disease that exists that may alter surgical management or preclude surgery. “St. Joe’s was the third largest contributor of patients in the province. Our involvement in the trial highlights our commitment to research and enhancing patient care,” says Dr. Hart.