The type of operation you need depends on where the cancer is in the pancreas.
For cancers of the head of the pancreas, you might have either an operation to remove the head of the pancreas (PPPD) or a Whipple's operation. For cancers in the body or tail of your pancreas you will have a distal pancreatectomy. These are major operations.
Because you keep part of your pancreas, you might not need to take insulin. You may 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.
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.
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.
This operation is the same as a PPPD but you also have part of your stomach removed. This diagram shows what your surgeon removes.
This diagram shows how the surgeon might repair what is left behind.
Removing the pancreas (total pancreatectomy)
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.
This diagram shows you how the surgeon repairs what is left behind.
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.
Removing the tail of the pancreas (distal pancreatectomy)
You have a distal pancreatectomy if the cancer is in the body or tail of your pancreas. This removes the body and tail and leaves the head. Your spleen is usually removed as well 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 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.
You have part of your pancreas left behind. So you should not need enzymes or insulin. But like the other types of surgery to cure pancreatic cancer, it involves a major operation and a long anaesthetic.
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. As you have them to try to cure your cancer it may feel worth taking some risks. Make sure you discuss the possible complications with your surgeon and ask any questions you have. 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.
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.
You will be given antibiotics through your drip if you develop an internal infection.
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. This could be 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. This could be a pancreatic fistula or more rarely a biliary fistula.
The cause is usually part of the internal stitching has come apart or broken down. For pancreatic fistulas it means that some of the digestive juices are able to get into your abdomen. And for biliary fistulas, bile can leak into the abdomen.
Around 1 in 10 patients (10%) having major pancreatic surgery will have a pancreatic 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. 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.
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.
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.