Surgery

Surgery to remove a tumor offers the best chance for long term control of all types of pancreatic cancer.  If a tumor is able to be surgically removed, it is called resectable.  About 15-20% of patients with pancreatic adenocarcinoma have tumors which are considered surgically resectable. 

When is surgery used?
In general, a pancreatic tumor is considered resectable if it has not spread beyond the pancreas and does not involve major arteries. If veins are involved, a qualified surgeon may be able to perform a vein resection. A vein resection typically adds an extra 60-90 minutes to the length of the surgery.
Determining a patient’s eligibility for surgery is not always easy. Even sophisticated imaging tests may not provide a perfect picture of the tumor. In some cases, during surgery, the surgeon will find that the cancer has spread and the operation will be ended. If surgery to remove the tumor is not possible, palliative procedures may be considered.

How should I choose my surgeon?
Pancreatic surgery is very complicated, especially the most common surgery, the Whipple procedure.  It is important to seek out a surgeon at a hospital that does a high volume, or large number, of these procedures.  Studies show that patients who undergo pancreatic surgery performed by an experienced surgeon have fewer complications and better outcomes.  When finding a surgeon, it is encouraged to ask how many pancreatic surgeries he or she performs each year.

The Pancreatic Cancer Action Network’s Patient and Liaison Services (PALS) Associates can provide patients and families with a listing of institutions and doctors who perform a high volume of pancreatic surgeries.  PALS Associates can also provide research articles supporting the benefits of getting pancreatic surgery at a high-volume institution.

What are the different types of pancreatic surgeries?
Different types of surgery are performed depending on the location of the tumor within the pancreas:

Whipple procedure (pancreaticoduodenectomy)
Distal pancreatectomy
Total pancreatectomy

How will I feel after undergoing pancreatic surgery?
After pancreatic surgery, it can take a patient anywhere from a few months to a year to feel relatively “normal” again.  It takes time for the digestive system to start working again and some patients find that they must make permanent changes in their diet to ease symptoms such as diarrhea, gas, and stomach pain.

Are surgeries for pancreatic cancer usually given with other treatments?
Sometimes treatment is given before surgery is performed to remove a pancreatic tumor.  This treatment, called neoadjuvant therapy, generally involves chemotherapy or chemotherapy with radiation therapy.  The goal of neoadjuvant treatment is to reduce the size of the tumor so that it is more easily removed during surgery.

Often, adjuvant therapy, or treatment that is given after the surgical removal of all or part of the pancreatic tumor, is given.  After surgery, patients are at risk for recurrence, or reappearance, of the cancer.  Recurrence can occur when a microscopic amount of the cancer spreads prior to the surgery.  The aim of adjuvant therapy is to kill microscopic cancer cells that may be present while their numbers are small, thereby preventing recurrence of a tumor.

What are palliative surgeries for pancreatic cancer?
Surgical procedures that do not involve removing the tumor may be performed to relieve, or palliate, symptoms.  Palliative procedures may relieve symptoms of jaundice, pain, nausea, and/or vomiting that are caused by blockage of the bile duct and/or stomach.  There are four main palliative surgeries for pancreatic cancer.

Biliary bypass and Gastric bypass
Stent Placement
Celiac Plexus

How will I feel after undergoing palliative pancreatic surgery?
The goal of palliative surgeries is to relieve jaundice, pain, nausea, and/or vomiting.  It is possible, but not common, for an infection to develop around a stent if it does not provide proper drainage.  Fever or a return of jaundice may indicate infection and require emergency treatment.  Anyone who suspects infection due to blockage of a stent should contact his or her doctor or the emergency room immediately.

 

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