Problems after pancreatic cancer surgery
All operations to remove pancreatic cancer is major surgery and it takes place in specialist centres.
As with any operation, there is a risk of complications. A complication is anything that happens after surgery that makes your recovery more difficult. For example, chest infections and blood clots are possible complications after any surgery.
Before offering surgery to you, your doctors make sure the benefit of having the operation outweighs the possible risks.
Your doctors will talk to you about the possible complications of the surgery and 
before you sign the consent form to have the operation. Your doctors and nurses monitor you very closely after the operation to check for problems.
Some complications can be serious and life threatening. But they are becoming less common as surgery is done at specialist centres where the surgeons do more of these operations.
Some of the possible problems after having surgery to remove pancreatic cancer include:
Infection, abscesses and fluid collection
Having major surgery causes your body to make extra fluid in the area. Your surgeon puts drains in your tummy (abdomen) during the operation to help prevent fluid collecting inside your body. If fluid collects internally around the operation site, it may become infected. This is known as an abscess. Sometimes this is a sign of a problem with the internal joins after surgery.
You have antibiotics through your drip if you develop an internal infection.
Your doctor may need to drain any abscesses or fluid that has collected internally. They usually do this by using x-ray or ultrasound to help guide a needle or tube into place.
Other possible sites for infection are where there is a break in the skin. This can include your wound and where you have drains. After your operation your nurse and surgeon will check on these areas to make sure you do not develop infections. Possible symptoms include:
- red, sore, or hot skin around the wound or drain
- discharge such as pus coming from the site
- generally feeling unwell
- a high temperature (fever)
Let your nurse or doctor know if you have any of these symptoms.
If you have had your spleen removed
The spleen has several main roles. These include:
- filtering the blood
- fighting against infection
- maintaining the correct number of
blood cells our body needs - removing worn out
red blood cells
Some types of surgery for pancreatic cancer mean you will have your spleen removed. Without a spleen you will be more at risk of getting an infection. You have this risk for the rest of your life.
To help prevent infection in the future, you will need to have vaccinations. Some of these you will need to repeat. For example, you should have the flu vaccine every year.
Your doctor may also suggest taking antibiotics. This is usually for the rest of your life because of these changes to your immune system.
In case of a medical emergency, you should carry a card saying you have had surgery to remove your spleen.
Chest infection
A chest infection is a common complication of many operations. It happens because you are not moving around 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.
Your and nurses will get you up as soon as possible to help you get moving.
Below is a short video showing breathing and circulation exercises after surgery. Click on the arrow to watch it.
Breathing and circulation exercises after surgery
These exercises help prevent you developing a chest infection or blood clots in your legs after surgery. These problems are more likely when you are not moving around as you would normally.
You can do these breathing exercises while sitting up in a chair or in a bed or whilst lying down.
Relax your shoulders and upper chest.
Take a slow, deep, comfortable breath in and hold for a couple of seconds, then slowly breathe out.
Repeat this 3 times.
You can start these breathing exercises as soon as you come round from your anaesthetic.
You should try to do them every hour when awake until you are fully mobile.
If you need to cough, support your wound with your arms, a pillow or a rolled up towel.
If you are struggling to clear any phlegm, try a hu. This is where you breathe out in a short, sharp manner as if you were trying to steam up a mirror.
You should move about as soon as possible after your operation. But while you are not as mobile, try to keep your legs moving to encourage better circulation.
You can do these exercises in a bed or in a chair.
One foot at a time point your toes away from you then pull your toes towards your chin.
Try to do 10 of these on both feet at least 2-3 times an hour.
The next exercise is circling your ankles. One at time circle your ankles, clockwise and then anticlockwise. Repeat this 10 times with each ankle 2-3 times an hour.
An abnormal opening (fistula)
The word fistula means opening. This could be a pancreatic fistula or more rarely a biliary fistula.
This may happen because the tissues that have been joined together aren't healing properly. Some of the internal stitching may have come apart. For pancreatic fistulas it means that some of the digestive juices are able to get into your tummy (abdomen). And for biliary fistulas, can leak into the abdomen.
If you get a fistula, you will have a wound drain put in and have antibiotics and drugs to lessen the secretions from the pancreas. The drains will be left in until the fistula dries up. The fistula then heals on its own. Rarely, the surgeon has to operate again to remove the leaking pancreas.
Bleeding
You may have bleeding straight after your operation. This could be because a stitched blood vessel is leaking or because your blood is not clotting properly.
Bleeding a week following surgery can happen because there is infection or a fistula forming. How bleeding is treated depends on what is causing it. Some people may need a .
Blood clots
Blood clots (deep vein thrombosis, DVT) are a possible complication of having surgery as you are not moving about as much. DVTs 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.
Delayed gastric emptying
Delayed gastric emptying (DGE) is a common complication after pancreassurgery. It’s more common with people who have had a pylorus preserving pancreaticoduodenectomy (PPPD). It means the stomach takes a long time to empty its contents into the small intestine.
Having DGE means you might feel uncomfortable due to a full stomach. Other symptoms include:
- feeling or being sick
- tummy (abdominal) pain
- feeling bloated
- heartburn or indigestion
- being unable to finish a meal as you feel full sooner
Some of the possible treatments can involve medicines to help move your food through your stomach faster. You may need painkillers and medicines to help with sickness. Other treatment might involve changing what you eat and how often you eat. And you may need a feeding tube (nasogastric tube) in if you haven’t got one already. The tube is to help remove the contents of your stomach to prevent you from being sick.
Diabetes
Your pancreas is responsible for making . Insulin keeps the sugar levels (glucose) in our blood at a stable level. Having diabetes means you don’t make enough insulin.
If your pancreas was completely removed, you will have to take insulin. This is because you won't be making your own insulin.
You have insulin as a small injection under the skin. You will have to check your blood sugar levels regularly. You do this by pricking your finger and squeezing a drop of blood onto a testing strip. You may have a small device on your skin which continually measures your sugar levels. The device has a little sensor that sits just beneath the skin.
If you had part of your pancreas taken out, you will probably still make enough insulin. Your doctor will need to keep a very close eye on your blood sugar to make sure you don't develop diabetes.
Malabsorption
This means you are not breaking down food as it passes through the digestive system. So you are not absorbing any nutrients, proteins or vitamins from your food. Symptoms can include:
- weight loss
- pale or yellow poo that smells quite bad
- oily poo that is difficult to flush away
- passing more wind that usual
- burping
- diarrhoea
The pancreas makes digestive juices which contain enzymes. These enzymes help break down food into very small fragments. These fragments are absorbed into the body through the small bowel.
After pancreatic surgery the amount of digestive juice lessens, or you don’t make any. This depends on what type of surgery you have had. To help with this you take pancreatic enzyme supplements to replace these enzymes.
Heart problems
You will have had heart tests before your surgery, but it is a big operation and increases the strain on your heart. Some people develop heart problems after surgery that they did not have before.
