Pancreas Surgery

Pancreas Surgery

Two general types of surgery can be used for pancreatic cancer:

Whipple procedure (pancreaticoduodenectomy)

This is the most common operation to remove a cancer in the head of the pancreas.

During this operation, the surgeon removes the head of the pancreas and sometimes the body of the pancreas as well. Nearby structures such as part of the small intestine, part of the bile duct, the gallbladder, lymph nodes near the pancreas, and sometimes part of the stomach are also removed. The remaining bile duct, stomach and pancreas are then attached to the small intestine so that bile and digestive enzymes can still go into the small intestine. Most often, this operation is done through an open incision. Small proportion can be done laparoscopically, which is sometimes known as keyhole surgery (see What’s New in Pancreatic Cancer Research?) or via hybrid approach to minimise the incision.

A Whipple procedure is a very complex operation that requires a surgeon with a lot of skill and experience. And in our centre, we have less than 1% risk from the procedure. To have the best outcome, it’s important to be treated by a surgeon who does many of these operations and to have the surgery at a hospital where many of them are done.

Still, even under the best circumstances, many patients have complications from the surgery. These can include:

• Leaking from the various connections between organs that the surgeon has to join
• Infections
• Bleeding
• Trouble with the stomach emptying after eating
• Trouble digesting some foods (which might require taking some pills to help with digestion)
• Weight loss
• Changes in bowel habits

Distal pancreatectomy

In this operation, the surgeon removes only the tail of the pancreas or the tail and a portion of the body of the pancreas. The spleen is usually removed as well. The spleen helps the body fight infections, so if it’s removed you’ll be at increased risk of infection with certain bacteria. To help with this, doctors recommend that patients get certain vaccines before this surgery. +

This surgery is used to treat cancers found in the tail and body of the pancreas. Unfortunately, many of these tumours have usually already spread by the time they are found and surgery is not always an option.

Total pancreatectomy

This operation removes the entire pancreas, as well as the gallbladder, part of the stomach and small intestine, and the spleen. This surgery might be an option if the cancer has spread throughout the pancreas but can still be removed. But this type
of surgery is used less often than the other operations because there doesn’t seem to be a major advantage in removing the whole pancreas, and it can have major side effects.

It’s possible to live without a pancreas. But when the entire pancreas is removed, people are left without the cells that make insulin and other hormones that help maintain safe blood sugar levels. These people develop diabetes, which can be hard to manage because they are totally dependent on insulin shots. People who have had this surgery also need to take pancreatic enzyme pills to help them digest certain foods.

Before you have this operation, your doctor will recommend that you get certain vaccines because the spleen will be removed.