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Having your operation for pancreatic cancer

Men and women discussing pancreatic cancer

This page is about what happens when you have surgery for cancer of the pancreas. You can find the following information

 

A quick guide to what's on this page

Before your operation for pancreatic cancer

Before your surgery, you will need tests to make sure you are fit enough for your anaesthetic and to make a good recovery. These may include blood tests, a chest X-ray, tests to check that your heart is healthy and to see how well your lungs work. You will also need to learn breathing and leg exercises.

About 1 to 2 weeks before surgery you may have an appointment at the hospital pre assessment clinic. This prepares you for your operation and makes sure you are in the best possible health before surgery. You are likely to meet several members of your multi disciplinary team, including a surgeon, dietician and physiotherapist. It is a good idea to take a list of any questions you have to this appointment.

You usually go into hospital the day before or morning of your surgery.

Immediately after your operation

When you wake up, you are likely to have several tubes in place to give you fluids and painkillers, and to drain the wound, drain your urine, and drain fluid from your stomach to stop you feeling sick. If you have had major surgery to your pancreas, you may also have a pump containing insulin.

It is important to tell your doctor or nurse as soon as you feel any pain. They need your help to find the right type and dose of painkiller for you.

After surgery to any part of the digestive system, the bowel usually stops working for a while. You will not be able to eat or drink anything straightaway. Your surgeon will tell you when you can start drinking sips of water. Gradually the amount you are allowed to drink will increase. And soon you will be able to try other fluids and then slowly start eating.
 

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

 

 

What happens before your operation

Before your surgery, you will need

  • Blood tests to check your general health and kidney function
  • A chest X-ray to check your lungs are healthy
  • Tests to check your heart is healthy (ECG, MUGA scan and echocardiogram)
  • Tests to see how well your lungs work (Lung function tests)

These tests are to make sure you are fit enough for your anaesthetic and to make a good recovery from your surgery. You may have had some of these tests while your cancer was being diagnosed. You may need blood tests often because the balance of chemicals in your blood can change so quickly. It is important that your surgeon knows your blood chemical levels accurately, so these need to be up to date.

 

The pre assessment clinic

About 1 to 2 weeks before your surgery you will have an appointment at the hospital pre assessment clinic. This prepares you for your operation and makes sure you are in the best possible health before surgery. You may have some of the tests mentioned above if you haven't had them already. You are likely to meet several members of your multi disciplinary team, including a surgeon, nurse, dietician and physiotherapist.

A senior member of the surgical team will give you information about your surgery, the benefits and possible risks and what to expect afterwards. You may also meet the anaesthetist who will make sure you are fit enough for surgery. You may sign the consent form to agree to the operation during this appointment.

The nurse will check your general health, weigh you, and take your blood pressure, pulse and temperature. They may take blood tests and arrange any other tests if needed. They will assess what help you may need after surgery once you are well enough to go home. They can also help answer any questions you may have.

The physiotherapist will assess how well you can move around and let the doctors know if there are any issues that may affect your recovery after surgery. They will also teach you leg and breathing exercises to do after your operation to help with recovery.

The dietician will give you help and advice about managing your diet before and after your surgery. You may need to eat a special diet before your operation. This is to build you up for your surgery. You may need to eat a high calorie diet that contains lots of carbohydrate and protein, but is low in fat. This is because people with pancreatic disease find fat difficult to digest.

Do ask as many questions as you need to during this appointment. It may be a good idea to write down all your questions to take with you. There are some suggestions for questions at the end of this section. The more you know about what is going to happen, the less frightening it will seem. Don't worry if you think of more questions later. Just speak to your clinical nurse specialist or the nurses on the ward. They can answer your questions or ask the doctor to talk to you again.

 

Learning breathing and leg exercises

You can help yourself to get better by doing these exercises after your operation. Your physiotherapist or nurse will teach you the exercises. You should do them as often as you are told you need to.

Breathing exercises will help to stop you getting a chest infection. If you smoke, it will really help if you can stop at least a few weeks before your operation. You will be less likely to get a chest infection afterwards if you do stop.

Leg exercises help to stop clots forming in your legs. You will also have daily injections of blood thinning drugs, called anticoagulants, to stop the blood from clotting so easily. These usually start just before the surgery and continue for several weeks afterwards. Your nurse may also give you compression stockings to wear.

Both chest infections and blood clots can happen because you are not moving around as much as you would normally. Your nurses will encourage you to get up and about as soon as possible after your operation.

Below is a short video showing breathing and circulation exercises after surgery. Click on the arrow to watch it.

 


 

View a transcript of the video showing breathing and circulation exercises after surgery (opens in new window)

 

At the hospital

You may go into hospital on the morning of the surgery or the day before. If you have any further questions the nurses can arrange for a member of the surgical team to come and talk to you again. You will sign the consent form for the operation if you didn't do it at the pre assessment clinic.

If you find eating and drinking difficult, you may have a drip (intravenous infusion) put into your arm before your surgery to give you fluids. This makes sure you are not dehydrated before your operation.

If you have been finding it difficult to digest fats, you may have become deficient in vitamin K. Vitamin K helps the blood to clot, so your vitamin K levels need to be corrected before your surgery. This can be done by taking tablets, having injections, or through your drip, if you have one.

Lastly, if you have body hair on your abdomen, you may need it shaved before your operation. This may reduce the risk of wound infection after surgery. You may have your shave in the operating theatre after you have had your anaesthetic.

 

What to expect immediately after surgery

If you have had very major surgery to try to cure your cancer, you will probably wake up in intensive care or a high dependency recovery unit. This is nothing to worry about. These are places where you can have one to one nursing care. And your surgeon and anaesthetist can keep a close eye on your progress. As soon as your doctors are sure you are recovering well, you will move back to the ward.

When you wake up, you will have several different tubes in place. This can be a bit frightening. But it helps to know what they are all for. You will have

  • Drips (intravenous infusions) to give you blood transfusions, and fluids until you are eating and drinking again
  • Tubes into your neck and arms to measure your blood pressure
  • One or more tubes coming out of your abdomen near your wound. These wound drains stop blood, bile and tissue fluid collecting around the operation site.
  • A tube down your nose into your stomach (nasogastric tube) to drain it and stop you feeling sick
  • A tube into your bladder (catheter) so that your urine output can be measured
  • A fine tube into your back that goes into your spinal fluid (epidural) to help relieve pain

You may have a blood pressure cuff on your arm and a little clip on your finger to measure your pulse. Keeping your blood pressure stable is very important after surgery to the pancreas. So, your nurses will measure your blood pressure very often for the first week or so. At first, they can monitor it through the tubes that go into your neck and arms. These go directly into your main blood vessels and give a more accurate measurement than a blood pressure cuff on your arm would. Your nurses will also check your urine output because it can help to show whether you have too much fluid or are becoming dehydrated.

You may have a couple of electronic pumps attached to your drips. One of these might have painkillers in it. You may have a hand control with a button to press to give yourself extra painkillers, as you need them. This is called patient controlled analgesia, or PCA.

If you have had major surgery to your pancreas, you may have another pump containing insulin. It is important that your insulin levels are kept within the normal range. Your nurse will test your blood insulin every hour or two at first. The pump will be set to give you just the amount of insulin you need.

 

Painkillers

You will almost certainly have pain for the first week or so. But there are many different painkilling drugs you can have. There are also different ways of having painkillers. You can have them by mouth or by injection. Doctors can also give anaesthetic drugs into your spinal cord - this is called an epidural.

It is important to tell your doctor or nurse as soon as you feel any pain. They need your help to find the right type and dose of painkiller for you. Painkillers work best when you take them regularly. If you have a button you can press to give yourself extra painkillers, do use it whenever you need to. You can't overdose because the machine is set to prevent that. Do tell your nurse if you need to press the button very often. You may need a higher dose in the pump.

 

Eating and drinking

After surgery to any part of the digestive system, the bowel often stops working for a while. You will not be able to eat or drink straightaway and so you have fluids through a drip.

If you have been ill for some time before your surgery, you may be very run down and malnourished. This is because the pancreas normally produces enzymes that help us digest our food. You may need extra help with nutrition to start with. There are several ways you can have help with this. You may have a white liquid called TPN through your drip. This stands for total parenteral nutrition. It contains proteins, fats and carbohydrates that can be easily absorbed by the body. Or you may have liquid food through a tube that goes down your nose and into the stomach (a nasogastric tube). Or you may have a tube into your stomach or bowel through the wall of the abdomen. 

Your surgeon will tell you once you can start drinking again. You will start with sips of fluid, often a day or two after surgery. Gradually the amount you are allowed to drink will increase, before slowly moving on to more solid foods. Once you are able to drink without being sick, your drip and nasogastric tube can come out.

 

Your wound

The wound from the operation will be covered up when you come round from the anaesthetic. It will be left covered for a couple of days. Then the dressings will be changed and the wound cleaned. The wound drains will be left in until they stop draining fluid. The bottles attached to them will be changed every day. Wound drains can usually be taken out about a week after your operation. This may be longer if there is any fluid leakage in the operation area. Your stitches will be left in for about 2 weeks.

Some surgeons leave a small tube (stent) inside you to help drain fluid from the pancreas after your surgery. This is usually removed about 3 weeks after the operation, so you have to come back to hospital to have it taken out in outpatients.

 

Getting up

This may seem impossible at first. Moving about helps you to get better, but you will need to start gradually. Your physiotherapist will visit you every day after your operation to help you with your breathing and leg exercises.

Your nurses and physio will encourage you to get out of bed and sit in a chair one or two days after your surgery. They will help you with all the drips and drains. Over the next couple of days, the tubes, bottles and bags will start to be taken out. Then, it will be much easier to get around and you will really feel that you are beginning to make progress.

 

Making progress

After a few days you will be up and about more. Gradually you will start to feel better. You will be able to eat more, but will have to stick to the diet that your dietician has planned for you. Your diet will be low in fat and quite bland. Frequent small meals are easier to manage than 3 large meals a day. There is more about diet after pancreatic surgery in the living with pancreatic cancer section.

Your doctors and nurses will continue to monitor your blood sugar level until it is stable. Unless you have had a total pancreatectomy, you shouldn't need to be on insulin for long. If your blood sugar is not stable by the time you go home, you and your family will be taught how to keep an eye on it. There is more about this in the diet after pancreatic cancer section.

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Updated: 18 December 2012