Pancreatic Cancer Overview

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Treating Pancreatic Cancer TOPICS

Surgery for pancreatic cancer

There are 2 types of surgery used for cancer of the pancreas:

  • Potentially curative surgery is used when tests suggest that it looks like all the cancer can be removed.
  • Palliative surgery may be done if tests show that the tumor is too widespread to be completely removed. Surgery is done to relieve symptoms or to prevent certain problems like blockage of the bile ducts or the intestine by the cancer.

Studies have shown that removing only part of the cancer does not help patients to live longer. Pancreatic cancer surgery is one of the hardest operations a surgeon can do. It is also one of hardest for patients to have. There may be problems, and it can take many weeks for patients to recover. Patients need to weigh the pros and cons of such surgery carefully.

Surgery to try to cure the cancer (potentially curative surgery)

The type of surgery most often done if it looks like the cancer can be cured is called the Whipple procedure. It is the most common type of surgery for cancer of the pancreas. In this surgery, parts of the pancreas are removed along with parts of the stomach and small intestine, the gallbladder, part of the common bile duct, and some nearby lymph nodes. This is a very complex operation. It is best done by a surgeon who has done it many times in a hospital that does at least 20 Whipple procedures per year. This surgery is a major operation that carries a fairly high risk of complications that may be fatal.

Only a very few number of cancers of the pancreas (about 1 out of 10) appear to be contained entirely within the pancreas when they are found. Only about half of these are found to be really only in the pancreas (and able to be removed completely) when surgery is done. But even when it looks like the cancer hasn’t spread, a small number of cancer cells may already have spread to other parts of the body. These cells can later grow into new tumors and cause many problems.

The spleen helps the body fight infections, so having it removed means a higher risk of certain infections. To help with this, doctors advise that patients get certain vaccines before a Whipple procedure.

Surgery to remove just part of the pancreas may be an option for a few patients with pancreatic cancer. For more information, see “Surgery for pancreatic cancer” in our document Pancreatic Cancer.

Palliative surgery

Because pancreatic cancer can progress quickly, most doctors do not advise surgery to relieve symptoms. Sometimes surgery may be tried in the hope of curing the patient, but during the operation the surgeon discovers this is not possible. In this case, the surgeon may continue the operation as a palliative procedure to relieve or prevent symptoms. For example, surgery can be used to relieve blockage of the bile duct. When this duct is blocked, it can cause pain and problems with digestion.

There are 2 options to relieve a bile duct blockage. One is to re-route the flow of bile from the common bile duct into the small intestine. This is known as bypass surgery. This requires a large cut (incision) and it may take weeks for the patient to recover. An advantage is that during the surgery, the doctor may be able to cut the nerves leading to the pancreas. This will reduce or get rid of any pain for the patient. Also, the doctor might re-route the stomach connection to the small intestine with the goal of preventing problems in the future.

A second way to treat bile duct blockage is to use metal tubes called stents to keep the bile duct open. The doctor puts the stents in using a thin, flexible tube called an endoscope. Over time the stents may get clogged and need to be replaced. Bigger stents may be used to keep the small intestine open, too. In most cases, of the use of stents has replaced palliative bypass surgery to relieve bile duct blockage.

Last Medical Review: 02/15/2013
Last Revised: 02/03/2014