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Surgery to try to cure pancreatic cancer

The type of operation you have depends on where the cancer is in the pancreas. The pancreas has 3 parts:

  • head (the wide end of the pancreas)
  • tail (the thin end)
  • body (the middle part of the pancreas)

For cancer in the head of the pancreas 

You might have a type of surgery called:

  • pylorus preserving pancreaticoduodenectomy (PPPD)
  • Whipple's procedure

For cancer in the body or tail of the pancreas

You might have surgery to remove the body and tail of your pancreas. It is called a distal pancreatectomy. 

Very rarely, your surgeon might plan to remove the whole pancreas. This is called a total pancreatectomy.

Surgery to remove the head of the pancreas

Pylorus preserving pancreaticoduodenectomy (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
  • part of your bile duct

The diagram below shows what your surgeon removes.

Diagram showing the parts the surgeon removes during a pylorus preserving pancreaticoduodenectomy (PPPD). This includes part of the pancreas, the first part of the small bowel, part of the bile duct and the gallbladder.

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 how the stomach, small bowel and pancreas are rejoined after a PPPD operation for cancer of the pancreas.

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 of the body removed for a Whipple operation for cancer of the pancreas. The parts removed are the lower part of the stomach, part of the small bowel, the head of the pancreas, gallbladder and part of the bile duct.

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

Diagram showing how the stomach and pancreas are joined to the bowel after a Whipple's operation for cancer of the pancreas.

Because you keep part of your pancreas with these operations, you might not need to take insulin Open a glossary item to control your blood sugar levels. You may also not need to take enzymes to help you digest food (although around 1 in 3 Whipple's patients do need enzymes). Your doctor will monitor your digestion and blood sugar to make sure you can manage on your own.

You will need support with your eating and drinking after these types of surgery. It might take time to return to a normal diet.

Removing the tail of the pancreas (distal pancreatectomy)

This removes the body and tail of the pancreas and leaves the head. Your surgeon also usually removes the spleen Open a glossary item because the tail of the pancreas is right next to it.

Distal pancreatectomy is not suitable for everyone. Many people have cancer that has spread and so it can't be completely removed. 

You have part of your pancreas left behind after the surgery. So you shouldn't need enzymes or insulin. But like the other types of surgery to remove pancreatic cancer, it involves a major operation and a long anaesthetic Open a glossary item.

Removing the whole pancreas (total pancreatectomy)

This surgery is not very common in the UK. 

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 removal of the pancreas

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

Diagram to show the removing of the pancreas

You must be fit enough for such major surgery, this is so you can cope with the long general anaesthetic and get over the operation. 

Losing your pancreas will affect your digestive system. You will also have diabetes. Losing your spleen increases the risk of infection and can affect your blood clotting.

After the surgery you will:

  • 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 some time to get back to eating normally after this type of surgery. You may have problems absorbing food and with diarrhoea.

Keyhole (laparoscopic) surgery

In some specialist centres, you may have your operation as keyhole (laparoscopic) surgery.

This type of surgery is only suitable for a small number of people. It is more commonly used for distal pancreatectomies, particularly for small pancreatic neuroendocrine tumours.

Your surgeon makes several small cuts in your abdomen instead of one large cut, as for more traditional open surgery. Your 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 uses the instruments to remove the tumour while watching what they are doing on the screen.

In a few centres, the surgeons may use a special machine (robot) to help with laparoscopic surgery. This is called assisted robotic surgery or da Vinci surgery.

The surgeon sits at a control unit a few feet away from the patient. The surgeon controls the movement of a set of robotic surgical equipment, guided by a video camera. This gives them a 3D view, which they can magnify a number of times. This helps them carry out difficult operations using very precise movements.

The photo below is an example of robotic surgery. You can see the surgeon sitting at the control unit on the right of the picture.

Photograph of Robotic surgery for prostate cancer

Laparoscopic surgery may cause less pain and the recovery time may be quicker compared to open surgery. This is still quite a new way of doing surgery for pancreatic cancer and more research is needed.