Surgical removal (resection) of the tumour is the most common treatment for people with early-stage pancreatic cancer who are in good health. Before the surgery, your treatment team may recommend that you have chemotherapy, with or without radiation therapy, to shrink the tumour. This is known as neoadjuvant therapy.
The aim of surgery for early pancreatic cancer is to remove all the tumour from the pancreas as well as the surrounding tissue. The type of surgery you have will depend on the size of the tumour and where it is located. All surgery has risks and potential complications, so your surgeon will weigh these up against the benefits, taking into account your general health and your preferences.
- Whipple procedure or pancreaticoduodenectomy
- Distal pancreatectomy
- Total pancreatectomy
- Surgery to relieve symptoms
Recovery after surgery can take some time, but there are ways to deal with the common issues that arise.
The Whipple procedure (pancreaticoduodenectomy) is a major operation that is done by a specialised pancreatic or hepato-pancreato-biliary (HPB) surgeon.
Before the Whipple procedure
The surgeon removes the part of the pancreas with the cancer (usually the head); the first part of the small bowel (duodenum); part of the stomach; the gall bladder; and part of the bile duct.
After the Whipple procedure
Then the surgeon reconnects the remaining part of the pancreas, bile duct and stomach (or duodenum) to different sections of the small bowel to keep the digestive tract working. This allows food, pancreatic juices and bile to continue to flow into the small bowel for the next stage of digestion. Most people need to adjust their diet after a Whipple procedure.
|Find out about tips on managing dietary problems after a Whipple procedure.|
The surgeon removes only the tail of the pancreas, or the tail and a portion of the body of the pancreas. The spleen is usually removed as well. The spleen helps the body fight infections, so if it is removed you are at higher risk of some bacterial infections. Your doctor may recommend vaccinations before and after this surgery.
When cancer is large, or multiple tumours are found, the entire pancreas and spleen may be removed, along with the gall bladder, common bile duct, part of the stomach and small bowel, and nearby lymph nodes. This is called a total pancreatectomy.
It is possible to live without a pancreas. However, the body will no longer produce insulin, so you will have type 1 diabetes and need regular insulin injections. You will also need to take pancreatic enzyme supplements to help digest certain foods. It is crucial that an endocrinologist is part of your MDT to help guide your adjustment to life without a pancreas.
Surgery to relieve symptoms
During the surgery to remove the cancer, the surgeon may find that the cancer has spread (metastasised) or grown into one or more of the major blood vessels in the area. This may occur even if you had several scans and tests beforehand.
If this happens, the surgeon will not be able to remove the tumour. However, the surgeon may be able to perform procedures that will relieve some of the symptoms caused by the cancer. Find out more in Advanced pancreatic cancer.
Surgery for early pancreatic cancer may be done using different techniques. Open surgery involves one larger cut in the abdomen. Laparoscopic surgery involves several small cuts in the abdomen. The surgeon inserts the instruments through these cuts and watches a screen to perform the operation. Robotic-assisted surgery uses a robotic device to help the surgeon perform laparoscopic surgery.
Compared to open surgery, laparoscopic surgery and robotic-assisted surgery usually mean a shorter hospital stay, less bleeding, a smaller scar and a faster recovery
Talk to your surgeon about what options are available to you and check if there are any extra costs involved.