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 all of the cancer can be removed.
- Palliative surgery may be done if tests show that the tumor is too widespread to be removed completely. This surgery is done to relieve symptoms or to prevent certain problems like blockage of the bile ducts or the intestine by the cancer. But it is not meant to try to cure the cancer.
Studies have shown that removing only part of the cancer does not help patients live longer, so potentially curative surgery is only done if the surgeon thinks all of the cancer can be removed. This is one of the hardest operations a surgeon can do. It is also one of hardest for patients to have. It can cause serious problems and can take many weeks to recover from. Patients need to weigh the pros and cons of such surgery carefully.
Surgery to try to cure the cancer (potentially curative surgery)
Fewer than 1 in 5 pancreatic cancers look to be only in the pancreas when they are found. Even then, not all of these cancers turn out to be truly resectable once the surgery is started. Sometimes it becomes clear during the operation that the cancer has grown too far to be removed completely. If this happens, the operation might be stopped, or the surgeon might continue with a smaller operation with a goal of relieving or preventing symptoms (see “Palliative surgery” below). This is because the planned operation would be very unlikely to cure the cancer and could still lead to major side effects. It would also lengthen the recovery time, which could delay other treatments.
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 small intestine, the gallbladder, part of the bile duct, nearby lymph nodes, and sometimes part of the stomach. 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 15 to 20 Whipple procedures per year. This surgery is a major operation that carries a fairly high risk of complications that may be fatal.
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.
Because pancreatic cancer can progress quickly, most doctors do not advise major 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, problems with digestion, jaundice, and other symptoms. There are 2 main options to relieve a bile duct blockage.
Stent placement: The most common way to treat bile duct blockage does not involve actual surgery. Instead, small tubes (usually made of metal) called stents are placed inside the duct to keep it open. The doctor puts the stents in using a thin, flexible tube called an endoscope that is passed down the throat, often during an ERCP (see “How is pancreatic cancer found?”).
Over time the stents might get clogged and need to be replaced. Bigger stents can be used to keep the small intestine open, too.
Bypass surgery: In people who are healthy enough, another option is surgery to re-route the flow of bile from the common bile duct into the small intestine, avoiding the pancreas. This often requires a large cut (incision), from which it can take weeks to recover. But sometimes it can be done through a few small cuts in the belly using special long surgical tools. (This is known as laparoscopic or keyhole surgery.)
Having a stent placed is often easier and people recover faster, which is why this is done more often than bypass surgery. But surgery can have some advantages, such as:
- It can often give longer-lasting relief than a stent, which might need to be cleaned out or replaced.
- It might be an option if a stent can’t be placed for some reason.
- During surgery, the surgeon can cut the nerves leading to the pancreas or inject them with alcohol to relieve pain caused by the cancer.
Sometimes during this surgery, the end of the stomach is disconnected from the first part of the small intestine and attached to it farther down. (This is known as a gastric bypass.) This can help avoid problems later on because the cancer can often grow and block the first part of the intestine.
For more about surgery as a treatment for cancer, see our document Understanding Cancer Surgery: A Guide for Patients and Families.
Last Medical Review: 08/01/2014
Last Revised: 02/01/2016