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Surgery for pancreatic cancer

Pancreaticoduodenectomy; Whipple procedure; Open distal pancreatectomy and splenectomy; Laparoscopic distal pancreatectomy; Pancreaticogastrostomy

Pancreatic surgery is done to treat cancer and other diseases of the pancreas.

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Description

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 and regulation of blood sugar levels. The pancreas has three parts called the head (the wider end), middle, and tail. When done to treat cancer, 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 robotic surgery 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 surgeries 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 part of the duodenum (first part of the small intestine) are also taken out. Sometimes, part of the stomach is removed.

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, part of the duodenum, and nearby lymph nodes are also removed. Sometimes, part of the stomach is removed.

Why the Procedure Is Performed

Your health care provider 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.

Risks

Risks for surgery and anesthesia in general are:

• Allergic reactions to medicines
• Breathing problems
• Heart problems
• Bleeding
• Infection
• Blood clots in legs or lungs

Risks for this surgery are:

• Leakage of fluids from the pancreas, bile duct, 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 provider to make sure medical problems such as diabetes, high blood pressure, and heart or lung problems are in good control.

Your surgeon 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 (ECG), for some people
• Endoscopic retrograde cholangiopancreatography (ERCP) to examine the bile and pancreatic ducts
• CT scan
• Ultrasound

During the days before the surgery:

• You may be asked to temporarily stop taking blood thinners such as aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), clopidogrel (Plavix), warfarin (Coumadin).
• Ask your surgeon which medicines you should still take on the day of your surgery.
• If you smoke, try to stop. Smoking can slow healing. Ask your provider for help quitting.
• Let your surgeon know about any cold, flu, fever, herpes breakout, or other illness you may have before your surgery. If you do get sick, your surgery may need to be postponed.

On the day of the surgery:

• You will likely be asked not to drink or eat anything for several hours before the surgery.
• Take any medicines your surgeon told you to take with a small sip of water.
• Follow instructions on when to arrive at the hospital. Be sure to arrive on time.

After the Procedure

Most people stay in the hospital 1 to 2 weeks after surgery.

• At first, you will be in the surgery recovery area or intensive care unit 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.

After you go home:

• Follow any discharge and self-care instructions you're given.
• You will have a follow-up visit with your surgeon 1 to 2 weeks after you leave the hospital. Be sure to keep this appointment.

You may require further treatment after you recover from surgery. Ask your provider about your situation.

Outlook (Prognosis)

Pancreatic surgery can be risky. If surgery is done, it should take place at a hospital where many of these procedures are performed.

References

Debrin JA. Pancreatic cancer: clinical aspects, assessment, and management. In: Jarnagin WR, Allen PJ, Chapman WC, et al, eds. Blumgart's Surgery of the Liver, Biliary Tract, and Pancreas. 7th ed. Philadelphia, PA: Elsevier; 2023:chap 62.

Jesus-Acosta AD, Narang A, Mauro L, Herman J, Jaffee EM, Laheru DA. Carcinoma of the pancreas. In: Niederhuber JE, Armitage JO, Kastan MB, Doroshow JH, Tepper JE, eds. Abeloff's Clinical Oncology. 6th ed. Philadelphia, PA: Elsevier; 2020:chap 78.

Modi B, Shires GT. Pancreatic cancer, cystic pancreatic neoplasms, and other nonendocrine pancreatic tumors. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 60.

Review Date: 9/9/2023  

Reviewed By: Debra G. Wechter, MD, FACS, General Surgery Practice Specializing in Breast Cancer, Virginia Mason Medical Center, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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