Surgery for pancreatic cancer
Pancreatic surgery is done to treat cancer of the pancreas gland.
Pancreaticoduodenectomy; Whipple procedure; Open distal pancreatectomy and splenectomy; Laparoscopic distal pancreatectomy; Lancreaticogastrostomy
The pancreas is located behind the stomach, between the duodenum (the first part of the small intestine) and the spleen, and in front of the spine. It helps in food digestion. The gland has three parts called the head (the wider end), middle, and tail. All or part of the pancreas is removed depending on the location of the cancer tumor.
Whether the procedure is performed laparoscopically (using a tiny video camera) or using a robot depends on:
- The extent of the surgery
- The experience and number of surgeries your surgeon has performed
- The experience and number of surgeries performed at the hospital you are going to use
The surgery is done in the hospital with general anesthesia so you are asleep and pain free. The following types of surgery are used in the surgical treatment of pancreatic cancer.
Whipple procedure: This is the most common surgery for pancreatic cancer.
- A cut is made in your belly and the head of the pancreas is removed.
- The gallbladder, bile duct, and parts of the stomach and small intestine are also taken out.
Distal pancreatectomy and splenectomy: This surgery is used more often for tumors in the middle and tail of the pancreas.
- The middle and the tail of the pancreas are removed.
- The spleen may also be removed.
Total pancreatectomy: This surgery is not done very often. There is little benefit of taking out the whole pancreas if the cancer can be treated by removing only part of the gland.
- A cut is made in your belly and the whole pancreas is removed.
- The gallbladder, spleen, parts of the stomach and small intestine, and the nearby lymph nodes are also removed.
Why the Procedure is Performed
Your doctor may recommend a surgical procedure to treat cancer of the pancreas. Surgery can stop the spread of cancer if the tumor has not grown outside the pancreas. Surgery does not stop cancer, but may be done to ease pain if the tumor has spread.
Risks for surgery are:
- Allergic reactions to medicines
- Breathing problems
- Heart problems
- Blood clots in legs or lungs
Risks for this surgery are:
- Leakage of fluids from the pancreas, stomach, or intestine
- Problems with stomach emptying
- Diabetes - if the body is unable to make enough insulin
- Weight loss
Before the Procedure
Meet with your doctor to make sure medical problems, such as diabetes, high blood pressure, and heart or lung problems are in good control.
Your doctor may ask you to have these medical tests done before your surgery:
- Blood tests (complete blood count, electrolytes, liver and kidney tests)
- Chest x-ray or electrocardiogram (EKG), for some patients
- Endoscopic retrograde cholangiopancreatography (ERCP) to examine the bile ducts
- CT scan
Tell your doctor or nurse:
- What drugs, vitamins, and other supplements you are taking, even ones you bought without a prescription
- If you are or could be pregnant
- If you have been drinking a lot of alcohol, more than 1 or 2 drinks a day
- If you are a smoker, stop smoking several weeks before the surgery. Your nurse or doctor can help.
- Ask your doctor which medicines you should still take on the day of your surgery.
On the day of your surgery:
- You will be asked not to drink or eat anything after midnight the night before your surgery.
- Take the medicines your doctor told you to take with a small sip of water.
- Your doctor or nurse will tell you when to arrive at the hospital.
- The surgery will take 4 to 6 hours.
After the Procedure
Most people stay in the hospital weeks 1 to 2 weeks after surgery. At first, you will be in the surgery area or intensive care where you can be watched closely.
You will get fluids and medicines through an intravenous (IV) catheter in your arm. You will have a tube in your nose.
You will have pain in your abdomen after surgery. You will get pain medicine through the IV.
You may have drains in your abdomen to prevent blood and other fluid from building up. The tubes and drains will be removed as you heal. Full healing takes 6 to 8 weeks. Avoid heavy activities during this period.
You will have a follow-up visit with your doctor 1 to 2 weeks after you leave the hospital.
You may require further treatment after you recover from surgery. Ask your doctor about your situation.
Very few cancers of the pancreas are found before the cancer has spread. Pancreatic surgery can be risky. If surgery is done, it should take place at a hospital where many of these procedures are performed.
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Mauro LA, Herman JM, Jaffee EM, Laheru DA. Carcinoma of the Pancreas. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff's Clinical Oncology. 5th ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2014:chap 81.