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Surgery to try to cure pancreatic cancer

All operations to remove pancreatic cancer are major surgery and there are risks attached to them. But they are done to try to cure your cancer so you may feel it is worth taking some risks. Make sure you discuss the possible complications with your surgeon and ask all the questions you need to.

On this page, there are details of different operations including

  • PPPD (pylorus preserving pancreaticoduodenectomy)
  • Whipple's operation
  • Removing the pancreas (total pancreatectomy)
  • Removing the tail of the pancreas (distal pancreatectomy)

If your cancer has spread then your surgeon will not offer you these operations. Unfortunately, only about 10 to 20 in every 100 people with pancreatic cancer (10 to 20%) are able to have surgery.
 

CR PDF Icon You can view and print the quick guides for all the pages in the treating pancreatic cancer section.

 

 

Taking out the head of the pancreas (PPPD)

Taking out the head of the pancreas is called pylorus preserving pancreaticoduodenectomy (PPPD). It involves removing

  • Part of your pancreas
  • Your duodenum (the first part of your small bowel)
  • Your gallbladder and part of your bile duct

The diagram below shows what your surgeon removes.

Diagram showing the area to be removed for a pylorus preserving pancreaticduodenectomy

So after the surgery, the tail of the pancreas is joined to a bit of your small bowel. This diagram shows how the surgeon might repair what is left behind.

Diagram showing the pancreas joined to the small bowel after pylorus preserving surgery for pancreatic cancer

 

Whipple's operation

This operation is the same as a PPPD but you also have part of your stomach removed. This diagram shows what your surgeon removes.

Diagram showing the parts removed with a Whipple's operation

And this diagram shows how the surgeon might repair what is left behind.

Diagram showing how the pancreas and bowel is joined back together after a Whipple's operation

These are the most common operations for cancers of the head of the pancreas that are suitable for surgery. This is major surgery. 

Because you keep part of your pancreas, you may not need to take insulin. And you may not need to take enzymes to help you digest food (although around 1 in 3 Whipple's patients do need enzymes). At first, your doctor will monitor your digestion and blood sugar to make sure you can manage on your own.

Getting over this type of surgery is hard work. It will take time to get back to eating even near normally. Your digestive system will never be the same as it was. There is more about this in the section about diet after pancreatic cancer. And there is more about this surgery in our section on having your operation for pancreatic cancer.

 

Removing the pancreas (total pancreatectomy)

This operation is not done very often in the UK. It is very major surgery. It involves taking out

  • The whole of the pancreas
  • Your duodenum
  • Part of the stomach
  • The gallbladder and part of your bile duct
  • The spleen
  • Many of the surrounding lymph nodes

This diagram shows you what the surgeon takes away.

Diagram showing the area removed for surgery to remove all of the pancreas

And this diagram shows you how the surgeon repairs what is left behind.

Diagram showing how the bowel is joined back together after a total pancreatectomy

To have a total pancreatectomy you must be fit enough to survive such major surgery and the long general anaesthetic. You must also be fit enough to cope with getting over the operation. Losing your pancreas will affect your digestive system. You will also have diabetes. Losing your spleen increases your risk of infection. And can affect your blood clotting.

After the surgery you will have to

  • Take enzymes to help you digest food
  • Have regular blood sugar checks and insulin injections
  • Have vaccinations and possibly take antibiotics for the rest of your life to prevent infections (if your spleen has been removed)

It will take time to get back to eating even near normally after this type of surgery. You may have problems absorbing food, and with diarrhoea. There is more about coping with eating in the section about diet after pancreatic cancer. There is also information about having your operation for pancreatic cancer.

 

Removing the tail of the pancreas (distal pancreatectomy)

If the cancer is in the body or tail of your pancreas you will have a distal pancreatectomy. The surgeon removes the body and tail of the pancreas and leaves the head. They usually take out your spleen as well, because the tail of the pancreas is right next to it.

Unfortunately, distal pancreatectomy is not suitable for everyone. Many people have cancer that has spread and so cannot be completely removed. Only around 1 in 20 patients (5%) with cancer of the body or tail of the pancreas can have this surgery.

As with PPPD or Whipple's, you will have part of your pancreas left behind. So you should not need enzymes or insulin. But as with all the other surgery to cure pancreatic cancer, it involves a major operation and long anaesthetic. There is more about this in the section about having your operation.

 

Possible complications of major pancreatic surgery

A complication is something that happens after surgery that makes your recovery more difficult. Chest infection or blood clots are both common complications after any surgery.

All these operations are very major surgery and there are risks attached to them. But they are done to try to cure your cancer so you may feel it is worth taking some risks. Make sure you discuss the possible complications with your surgeon and ask all the questions you need to. It is important that your family are given the chance to talk things through with the surgeon as well.

Complications are most likely with the biggest operations. The complication rate is lowest in specialist centres where the surgeons are more practised at doing this difficult surgery.

Overall, about 4 out of every 10 patients (40%) having the major operations have one or more complications. The most common complications include

If fluid collects internally around the operation site, it may become infected. Sometimes this is a sign of a problem with the internal joins after surgery. If you develop an internal infection, you will be given antibiotics through your drip. Abscesses or any fluid that has collected internally will need to be drained. This is usually done by putting in a needle or drainage tube. The needle or tube is guided into place with X-ray or ultrasound.

You may have bleeding straight after your operation because a blood vessel tie is leaking. Or because your blood is not clotting properly. Bleeding in the few days following surgery can happen because there is infection or a fistula forming. How bleeding is treated depends on what is causing it.

The word fistula means opening. In this case, it means that part of the internal stitching to the digestive system has come apart or broken down. So some of the digestive juices are able to get into your abdomen. Around 1 in 10 patients (10%) having major pancreatic surgery will have a fistula. If you get one, you will have a wound drain put in and have drugs to control the inflammation. The drains will be left in until the fistula dries up. The fistula then heals on its own. Sometimes, the surgeon has to operate again to repair the leak.

Blood clots (deep vein thrombosis, DVT) are a possible complication of having surgery as you are not moving about as much. DVT's can block the normal flow of blood through the veins. There is a risk that a blood clot can become loose and travel through the bloodstream to the lungs, causing a blockage (pulmonary embolism). Most blood clots can be successfully treated and steps are taken in hospital to reduce the risk of a clot developing in the first place.

Chest infection is a common complication of many operations. It happens because you are not moving around enough, or breathing deeply enough after your surgery. What you would normally cough up stays in your lungs and becomes a focus for infection. You can help to prevent this by doing your deep breathing exercises. The physiotherapists and nurses will get you up as soon as possible to help you get moving.

You will have had heart tests before your surgery, but these are very big operations and do increase the strain on your heart. Some people develop heart problems after surgery that they did not have before.

Complications after surgery can be very serious. They are becoming less common as surgeons get better at deciding who is likely to make a good recovery from this type of surgery. And as more of these operations are done in specialist centres. But even so, as many as 1 in 20 people (5%) who have the most major surgery may die directly as a result of complications after their operation.

 

Keyhole surgery

In some specialist centres, you may have your operation as keyhole (laparoscopic) surgery. This is more likely for distal pancreatectomy, particularly for small pancreatic neuroendocrine tumours (PNETs) and cystic tumours. This type of surgery is only suitable for a small number of people. And is only carried out by surgeons who are experienced in both pancreatic surgery and advanced laparoscopic techniques.

The surgeon makes several small cuts in your abdomen instead of making one large cut, as you'd have with traditional open surgery. The surgeon passes a long narrow tube called a laparoscope, and other instruments, through the cuts. The laparoscope is connected to a fibre optic camera that shows pictures of the inside of the body on a video screen. The surgeon manipulates the instruments to remove the tumour while watching what they are doing on the screen.

Laparoscopic surgery may cause less pain and the recovery time may be quicker compared to open surgery. This technique is still relatively new for pancreatic tumours and so surgeons are monitoring the results of this type of surgery.

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Updated: 7 June 2014